Surgical stapler with staples of different sizes

ABSTRACT

One example of a surgical apparatus may include a staple holder; at least one feeder belt fixed to the staple holder; and staples integral with and frangibly separable from the feeder belt; where at least one of the staples is sized differently from at least one other staple.

This application is a continuation-in-part of U.S. patent applicationSer. No. 13/294,160, filed on Nov. 10, 2011, which in turn is adivisional of U.S. patent application Ser. No. 12/400,790, filed on Mar.9, 2009 (now U.S. Pat. No. 8,070,036), which in turn is acontinuation-in-part of U.S. patent application Ser. No. 12/263,171,filed on Oct. 31, 2008, which in turn is a continuation-in-part of U.S.patent application Ser. No. 11/956,988, filed Dec. 14, 2007 (now U.S.Pat. No. 7,954,683), which in turn is a continuation-in-part of U.S.patent application Ser. No. 11/851,379, filed Sep. 6, 2007 (now U.S.Pat. No. 7,988,026, all of which are hereby incorporated by reference intheir entirety.

FIELD OF THE INVENTION

The invention generally relates to surgical staples and stapling, andmore specifically to surgical staplers that contain differently-sizedstaples.

BACKGROUND

An endocutter is a surgical tool that staples and cuts tissue totransect that tissue while leaving the cut ends hemostatic. Anendocutter is small enough in diameter for use in minimally invasivesurgery, where access to a surgical site is obtained through a trocar,port, or small incision in the body. A linear cutter is a larger versionof an endocutter, and is used to transect portions of thegastrointestinal tract. A typical endocutter receives at its distal enda disposable single-use cartridge with several rows of staples, andincludes an anvil opposed to the cartridge. The surgeon inserts theendocutter through a trocar or other port or incision in the body,orients the end of the endocutter around the tissue to be transected,and compresses the anvil and cartridge together to clamp the tissue.Then, a row or rows of staples are deployed on either side of thetransection line, and a blade is advanced along the transection line todivide the tissue.

During actuation of an endocutter, the cartridge fires all of thestaples that it holds. In order to deploy more staples, the endocuttermust be moved away from the surgical site and removed from the patient,after which the old cartridge is exchanged for a new cartridge. Theendocutter is then reinserted into the patient. However, it can bedifficult and/or time-consuming to located the surgical site afterreinsertion. Further, the process of removing the endocutter from thepatient after each use, replacing the cartridge, and then finding thesurgical site again is tedious, inconvenient and time-consuming,particularly where a surgical procedure requires multiple uses of theendocutter. That inconvenience may discourage surgeons from using theendocutter for procedures in which use of an endocutter may benefit thepatient. Similar inconveniences may accompany the use of surgicalstaplers other than endocutters.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of an endocutter.

FIG. 2 is a cross-section view of a trocar port positioned in a patient.

FIG. 3 is a cross-section view of trocar ports positioned in a patient.

FIG. 4 is a perspective view of an exemplary feeder belt with three rowsof staples frangibly connected thereto.

FIG. 5 is a side view of the feeder belt of FIG. 4.

FIG. 6 is a top view of the feeder belt of FIG. 4.

FIG. 7 is a side view of an exemplary end effector of an endocutter thatutilizes the feeder belt of FIGS. 4-6.

FIG. 7A is a bottom view of a lower surface of an exemplary anvil of anendocutter.

FIG. 7B is a side cutaway view of a staple forming pocket defined in thelower surface of the anvil of FIG. 7A.

FIG. 8 is a perspective view of an exemplary feeder belt guide.

FIG. 9 is a side cross-section view of the feeder belt guide of FIG. 8,not including a feeder belt.

FIG. 10 is a side cross-section view of the feeder belt guide of FIG. 8,including a feeder belt.

FIG. 11 is a perspective view of an exemplary housing of a staple holderof the exemplary end effector of FIG. 7.

FIG. 12 is a perspective cutaway view of the exemplary end effector ofFIG. 7.

FIG. 13 is a perspective view of an exemplary wedge assembly.

FIG. 14 is a perspective view of an exemplary block of the exemplary endeffector of FIG. 7.

FIG. 15 is a perspective view of an exemplary cutter.

FIG. 16 is a side cutaway view of the exemplary end effector of FIG. 7.

FIG. 17 is a perspective view of a retainer of the exemplary endeffector of FIG. 7.

FIG. 17A is a perspective view of the underside of the retainer of FIG.17.

FIG. 18 is a perspective view of an exemplary feeder belt with two rowsof staples frangibly connected thereto.

FIG. 19 is a side view of the feeder belt of FIG. 18.

FIG. 20 is a top view of the feeder belt of FIG. 18.

FIG. 21 is a side cross-section view of an exemplary end effector of anendocutter that utilizes the feeder belt of FIGS. 18-20.

FIG. 22 is a perspective view of an exemplary housing of a staple holderof the exemplary end effector of FIG. 21.

FIG. 23 is a perspective view of a block of the exemplary end effectorof FIG. 21.

FIG. 24 is a detail cross-section view of the exemplary end effector ofFIG. 21 in the vicinity of the block.

FIG. 25 is a perspective view of another exemplary feeder belt with tworows of staples frangibly connected thereto.

FIG. 26 is a side view of the feeder belt of FIG. 25.

FIG. 27 is a top view of the feeder belt of FIG. 25.

FIG. 28 is a perspective view of the distal end of another exemplarywedge assembly.

FIG. 28A is a side view of the distal end of another exemplary wedgeassembly.

FIG. 29 is a perspective view of a blood vessel after transection by anendocutter.

FIG. 30 is a perspective view of sliding clamps, each in a firstposition relative to a corresponding feeder belt.

FIG. 31 is a side view of the sliding clamps of FIG. 30, each in a firstposition relative to a corresponding feeder belt.

FIG. 32 is a perspective view of the sliding clamps of FIG. 30, each ina second, clamping position relative to a corresponding feeder belt.

FIG. 33 is a side view of the sliding clamps of FIG. 30, each in asecond, clamping position relative to a corresponding feeder belt.

FIG. 34 is an exploded perspective view of the distal end of anexemplary endocutter.

FIG. 35 is a perspective view of another exemplary feeder belt with tworows of staples frangibly connected thereto.

FIG. 36 is a perspective view of an exemplary cutter including a camsurface defined thereon.

FIG. 37 is an exploded view of an exemplary handle of the endocutter.

FIG. 38 is a perspective cutaway view of the exemplary handle of FIG.37.

FIG. 39 is an exploded perspective view of the proximal end of anexemplary endocutter, distal to the handle thereof.

FIG. 40 is an exploded perspective view of a portion of the endocutterlocated between the views of FIGS. 34-39.

FIG. 41 is a perspective view of the proximal end of an exemplarydriver.

FIG. 42 is a perspective view of a center portion of the exemplarydriver of FIG. 41.

FIG. 43 is a perspective view of the distal end of an exemplary driver.

FIG. 44 is a perspective cutaway view of an exemplary staple holder andan exemplary clamp therein.

FIG. 45 is a detail perspective view of a connection between theproximal end of the exemplary clamp of FIG. 44 and an exemplaryovertube.

FIG. 46 is a perspective view of an exemplary top plate.

FIG. 47 is a side view of the exemplary top plate, an exemplary bottomplate, a central portion of the exemplary driver of FIG. 42, and a gear.

The use of the same reference symbols in different figures indicatessimilar or identical items.

DETAILED DESCRIPTION

Endocutter—Three Staple Rows

Referring to FIG. 1, an endocutter 2 includes an end effector 4 attachedto a shaft 6, which in turn is attached to a handle 8. The end effector4 may be one or more separate components that are connected to the shaft6, or may be fabricated integrally with the distal end of the shaft 6.Referring also to FIGS. 2-3, the end effector 4 and the shaft 6 may besized to pass through a standard trocar port 10 that may be placedthrough tissue 12 of a patient 14. Advantageously, the end effector 4may be sized to pass through a trocar port 10 having an opening between5-10 millimeters in diameter. Alternately, the endocutter 2 may be usedin the course of conventional open surgery, where a trocar port is notused. Alternately, the endocutter 2 may be used in the course ofminimally-invasive surgery, where access to the surgical site in thepatient is gained through a mechanism or structure other than a trocarport, such as the LAP DISC® hand access device of Ethicon Endo-Surgery,Inc., or where access to the surgical site in the patient is gainedthrough an incision or opening in which no port or other mechanism orstructure is placed.

The trocar port 10 is a hollow generally-tubular structure inserted intoan incision in tissue 12 of a patient to hold that incision open and toprevent damage to the tissue 12 defining the incision opening that mayresult from the motion of tools and other objects through the incision.The trocar port 10 may be made from plastic or any other suitablebiocompatible material. The trocar port 10 may have a substantiallycircular cross section, a substantially oval cross section, or any othersuitable cross section. The particular dimensions of a trocar port 10depend on the particular procedure to be performed on the patient 14,and may be any suitable dimensions. The trocar port 10 may be coupled toa cutting tool (not shown) through its center that makes an opening intissue 12, after which the trocar port 10 is placed into tissue 12. Thecutting tool may be a spike or other cutting or puncturing device, whichis removed from the trocar port 10 when the trocar port 10 is inposition in the chest wall. The combination of a trocar port 10 and acutting tool is standard in the art.

Referring to FIG. 1, the shaft 6 of the endocutter 2 extends proximallyfrom the end effector 4. The shaft 6 may be flexible or rigid. The shaft6 may be articulated in at least one location, if desired. Optionally,the shaft 6 may include a cutaway, trough or other feature (not shown)to allow a guidewire (if any) or other positioning aid that may be usedin the surgical procedure to remain in place during actuation of theendocutter 2.

The handle 8 may be attached to the proximal end of the shaft 6, or anyother suitable portion of the shaft 6. The shaft 6 may be fabricatedintegrally with the handle 8. Alternately, the shaft 6 and the handle 8may be two separate items that are connected together in any suitablemanner. The handle 8 may include any mechanism, mechanisms, structure orstructures that are suitably configured to actuate the end effector 4.The handle 8 may also include a source of stored energy for actuatingthe end effector 4. The source of stored energy may be mechanical (suchas a spring), electrical (such as a battery), pneumatic (such as acylinder of pressurized gas) or any other suitable source of storedenergy. The source of stored energy, its regulation, and its use inactuating the end effector 4 may be as described in the U.S. patentapplication Ser. No. 11/054,265, filed on Feb. 9, 2005, which is hereinincorporated by reference in its entirety. The handle 8 may instead, oralso, include a connector or connectors suitable for receiving storedenergy from an external source, such as a hose connected to a hospitalutility source of pressurized gas or of vacuum, or an electrical cordconnectable to a power source.

Referring to FIGS. 4-6, a portion of a feeder belt 16 is positionedwithin the end effector 4. The feeder belt 16 and associated hardwaremay be as set forth in U.S. patent application Ser. No. 11/956,988,filed Dec. 14, 2007, and U.S. patent application Ser. No. 11/851,379,filed Sep. 6, 2007, both of which are hereby incorporated by referencein their entirety. The feeder belt 16 may be a long, narrow, thin stripof material from which one or more staples 18 extend. The feeder belt 16may be fabricated from stainless steel, nickel-titanium alloy, or anyother suitable metallic or non-metallic material. The feeder belt 16 isflexible enough, and strong enough, to be advanced linearly and thenredirected around a nose or other structure in substantially theopposite direction, as described in greater detail below. Alternately,at least part of the feeder belt 16 may be rigid or at least partiallyrigid, such that the feeder belt 16 may be advanced or retractedsubstantially linearly without redirection about a structure, or may beotherwise manipulated. Each staple 18 may be shaped in any suitablemanner; the staples 18 may be shaped substantially the same as oneanother, or may be shaped differently. As one example, each staple 18 isgenerally V-shaped, and has two legs 20 extending from the base of theV-shape. Referring particularly to FIG. 5, one leg 20 of the staple 18may be generally straight, and the other leg 20 of the staple 18 may begently curved. However, the legs 20 may be shaped in a different manner.Further, each leg 20 may be shaped in the same manner. The staple 18need not be symmetrical, but can be fabricated symmetrically if desired.The base of the V-shape of the staple 18 may be curved, pointed orotherwise configured. One leg 20 of the staple 18 has a free end 22 thatmay be characterized as a tissue penetrating tip 22. The tissuepenetrating tip 22 may be sharpened, if desired, to facilitatepenetration of tissue. However, the legs 20 of the staple 18 may have across-section that is small enough that the tissue penetrating tip 22need not be sharpened in order to easily penetrate tissue. The other leg20 is attached at one end to the feeder belt 16. Advantageously, thatleg 20 is frangibly connected to the feeder belt 16. Thus, one end ofthe staple 18 may be attached to the feeder belt 16 and the other end ofthe staple 18 may be free. Alternately, the staple 18 may have three ormore legs 20, or may be shaped in any other suitable manner. The staples18 may be connected to the feeder belt 16 in any suitable orientation.As one example, one or more of the staples 18 are oriented generallyparallel to the longitudinal centerline of the feeder belt 16. That is,one or more of the staples 18 each may lie in a plane that is generallyparallel to the longitudinal centerline of the feeder belt 16, as shownin FIG. 6. As another example, one or more of the staples 18 each may beoriented in a direction angled relative to the longitudinal centerlineof the feeder belt 16. As another example, the staples 18 each may beoriented in a direction angled relative to the transverse direction,which is the direction perpendicular to the longitudinal centerline ofthe feeder belt 16.

The feeder belt 16 and staples 18 may be fabricated in any suitablemanner. As one example, a flat, thin sheet of material is laser cut intolong strips, after which each strip is laser cut to form fingers thereinthat are then bent into the shape of the staples 18. In this way, thestaples 18 and the feeder belt 16 form an integral structure. However,the feeder belt 16 and staples 18 may be fabricated in any othersuitable manner. As one example, the staples 18 and feeder belt arefabricated separately, and the staples 18 are then connected to thefeeder belt 16 by welding, adhesive, or any other method that provides afrangible connection between the staples 18 and the feeder belt 16.

A frangible connection between the feeder belt 16 and each correspondingstaple 18 may be made in any suitable manner. As one example, referringparticularly to FIG. 6, each feeder belt 16 may include at least one tab28 protruding laterally therefrom, or defined laterally in the centerthereof. Alternately, at least one tab 28 may be oriented differently.Advantageously, the tabs 28 result from laser cutting and subsequentmechanical deformation of the staples 18 during manufacturing, such thatthe tabs 28 and staples 18 are integral with the corresponding feederbelt 16. However, the tabs 28 and/or staples 18 may be fabricated andconnected to the feeder belt 16 in any other suitable manner. At leastone staple 18 may be attached to a corresponding tab 28 in any suitablemanner. The attachment between a staple 18 and the corresponding tab 28may be made in any suitable manner, and the connection between a staple18 and the corresponding tab 28 may have any suitable orientation. Asone example, at least one tab 28 is generally rectangular, and thecorresponding staple 18 extends from the proximal edge of thatrectangular tab 28. The staple 18 may be separable from the tab 28, at alocation generally at the intersection between the staple 18 and the tab28. The connection between a staple 18 and the corresponding tab 28 isstrong enough to hold the staple 18 securely in place relative to thefeeder belt 16 prior to deployment, and weak enough to be broken orotherwise separated from the tab 28 during or after deployment.Optionally, a staple 18 and/or tab 28 may include a weakened area at ornear their intersection, in order to facilitate separation between thestaple 18 and the feeder belt 16 during or after deployment. Theweakened area may have a reduced cross-sectional area, may be notched,or otherwise structurally weakened. Alternately, the weakened area mayalso, or instead, be physically treated or otherwise configured to beweaker than the surrounding material, while having substantially thesame physical dimensions as that surrounding material.

As shown in FIGS. 4-6, the staples 18 are in an initial configurationprior to being deployed. In the initial configuration, the staples 18 donot substantially contact one another. Alternately, at least two of thestaples 18 may contact one another in the initial configuration. Thestaples 18 each may lie substantially in a single plane. That is, thestaple 18 may be shaped such that a single plane extends through andsubstantially bisects the staple 18. Alternately, at least one staple 18does not lie substantially in a single plane. At least one staple 18 maybe positioned in a plane that is generally perpendicular to the feederbelt 16. Alternately, at least one staple 18 may be positioned in aplane that is angled differently relative to the feeder belt 16. One ormore rows 26 of staples 18 are connected to the feeder belt 16. Each row26 of staples 18 is the group of staples 18 positioned at substantiallythe same lateral location relative to the longitudinal centerline of thefeeder belt 16, and each row 26 of staples 18 is oriented generallylongitudinally. As best seen in FIG. 6, three rows 26 of staples 18 maybe attached to the feeder belt 16—one row 26 along each side of thefeeder belt 16, and one row 26 along the center of the feeder belt 16.The feeder belt 16 may form a continuous loop, or may have a discretebeginning and end that are not attached to one another. Alternately,more or fewer rows 26 of staples 18 may be attached to the feeder belt16. Each row 26 may extend along part, or all, or the length of thefeeder belt 16. Different rows 26 may extend different lengths along thefeeder belt 16.

Staples 18 in two or more different rows 26 along a single feeder belt16 may be arranged in any suitable manner relative to one another. Asone example, staples 18 in two or more different rows 26 along a singlefeeder belt 16 may be staggered relative to one another. That is, at agiven longitudinal position along a single feeder belt 16 at which astaple 18 in one row 26 is attached to the feeder belt 16, at least oneother row 26 does not have a staple 18 attached to that feeder belt 16.This staggering of the staples 18 promotes hemostasis in tissue treatedwith the end effector 4. As may be best seen in FIG. 6, the center row26 of staples 18 may be staggered relative to the rows 26 of staples 18along the lateral edges of the feeder belt 16. Alternately, two or morerows 26 of staples 18 may be staggered in a different manner.Alternately, staples 18 in two or more of the rows 26 along a singlefeeder belt 16 may be aligned with one another, along at least part ofthe length of the rows 26, such that at a given longitudinal positionalong the feeder belt 16 at which a staple 18 in one row 26 is attachedto the feeder belt 16, each other row 26 has a staple 18 attached to thefeeder belt 16 as well. Alternately, staples 18 in two or more rows 26along a single feeder belt 16 may be arranged differently alongdifferent longitudinal portions of that feeder belt 16. Staples 18 maybe arranged relative to one another in the same manner, or differently,on different feeder belts 16 of the endocutter 2.

The staples 18 in each row 26 may be substantially evenly spaced apartfrom one another. That is, the distance between any twolongitudinally-adjacent staples 18 in a row may be substantially thesame. Alternately, at least two longitudinally-adjacent staples 18 ineach row 26 may be spaced apart a distance different from the distancebetween two other longitudinally-adjacent staples 18. Such aconfiguration may be useful where the length of the staple line is notadjustable. The staple line to be created with the end effector 4 may befixed at a particular number of staples 18, and consequently the staples18 in each row may be grouped together in groups each having a lengthsubstantially the same as that fixed staple line. If so, each group ofstaples 18 in a row 26 may be separated from a adjacent group of staples18 by a blank space on the feeder belt 16, where that blank space mayhave any suitable length. Advantageously, no staples 18 extend from, orinto an area bounded by, the blank space of the feeder belt 16.

Referring also to FIG. 7, the end effector 4 may include a staple holder30 and an anvil 32. The anvil 32 may be movable relative to the stapleholder 30 to compress tissue therebetween. The anvil 32 may includestandard staple bending features defined therein to facilitate closureof the staples 18. Alternately, staple bending features may be omittedfrom the anvil 32. The anvil 32 may be pivotable relative to the stapleholder 30. As one example, at least one pin 34 may extend generallylaterally from the anvil 32 at a location at or near the proximal end ofthe anvil 32. Each pin 34 may be received by a trough 36, aperture, orother feature of the staple holder 30 that allows that pin 34 to rotatetherein and thereby allows the anvil 32 to pivot. Referring also to FIG.16, in this way, the distal end of the anvil 32 may be spaced apart fromand positioned above the staple holder 30 in a first, initial positionprior to clamping tissue, while the proximal end of the anvil 32 may beconnected to the staple holder 30. Alternately, the trough 36 may belocated in the shaft 6 of the endocutter, such that the anvil 32 ispivotally attached to the shaft 6 and movable relative to the stapleholder 30. Alternately, the anvil 32 may be connected to and/or movablerelative to the staple holder in a different manner. Alternately, thestaple holder 30 may be movable relative to the anvil 32. Alternately,the staple holder 30 and the anvil 32 may be movable relative to oneanother. The distal end of the staple holder 30 and the distal end ofthe anvil 32 may be blunt, in order to prevent inadvertent engagement oftissue with the end effector 4 during insertion of the end effector 4into the patient and motion of the end effector 4 to a treatment site.Advantageously, the staple holder 30 is fixed to a remainder of the endeffector 4 and/or the shaft 6, and is not detachable therefrom. As setforth in greater detail below, the staple holder 30 may be firedmultiple times without being withdrawn from the patient, such that thereis no need to withdraw the end effector 4 from the patient after eachfiring of staples 18 in order to replace a staple cartridge or othercomponent. Nevertheless, if desired the staple holder 30 may bedetachable from a remainder of the end effector 4 and/or the shaft 6;the end effector 4 may be detachable from the shaft 6; and/or the shaft6 may be detachable from the handle 8.

Referring also to FIG. 7A, the inner surface 202 of the anvil 32, whichis the surface of the anvil 32 oriented generally toward the stapleholder 30, may include staple forming pockets 204 defined therein. Asdescribed in greater detail below, referring also to FIGS. 18-20, 30-33and 35, as the staples 18 are deployed, the free end 22 of each staple18 may be forced into a corresponding staple forming pocket 204, wherebycontact between the free end 22 and proximal leg 196 of that staple 18causes that staple 18 to close. Referring also to FIG. 7B, each stapleforming pocket 204 may be shaped in any suitable manner. As one example,at least one staple forming pocket 204 may be asymmetrical, with atleast two sections having different radii of curvature. Experiment hasshown that closure of a staple 18 is improved by the use of a stapleforming pocket 204 having a first radius of curvature at a proximalsection 206 thereof, and a second, shorter radius of curvature at adistal section 208 thereof. The inner surface 202 of the anvil 32 mayinclude a generally longitudinal slot 210 defined therein, through whichat least part of the knife 90 may slide, as described in greater detailbelow. The slot 210 may have a substantially constant depth along atleast part of its length. A cam engagement feature 212 may be defined inthe slot 210, with a depth less than an adjacent segment of the slot210. The cam engagement feature 212, if present, may be sized and shapedto engage the cam surface 107 of the knife 90, as described in greaterdetail below.

The staple holder 30 may include any suitable components. Referring alsoto FIGS. 8-10, the staple holder 30 may include a feeder belt guide 40.The feeder belt guide 40 may be shaped in any suitable manner. Thestaple holder 30 may be configured such that the distal end of thefeeder belt guide 40 is the distal end of the end effector 4. If so, thedistal end 42 of the feeder belt guide 40 may be generally blunt. Theupper surface 44 of the distal end 42 of the feeder belt guide 40 may beangled generally upward, moving proximally along the feeder belt guide40. Alternately, the upper surface 44 of the distal end 42 of the feederbelt guide 40 may be shaped in any other suitable manner. One or moreapertures 46 may be defined in the upper surface 44 of the distal end 42of the feeder belt guide 40. Alternately, one or more of the apertures46 may be omitted, such that the upper surface 44 of the distal end 42of the feeder belt guide 40 is instead continuous. The distal end 42 ofthe feeder belt guide 40 may include a space 48 defined therein. Atleast one nose 50 may protrude distally into that space 48. Each nose 50may be curved, and may have a convex shape. As one example, each nose 50may have an arcuate shape, where that arc is a section of a circle.Alternately, at least one nose 50 may be shaped differently. As oneexample, at least one nose 50 may be shaped as two or more straightlines that collectively approximate a curve, roughly or smoothly.

Referring also to FIG. 12, the end effector 4 may include two feederbelts 16. In this way, staples 18 can be deployed on either side of anincision or transection to be made in tissue. Alternately, the endeffector 4 may include only one feeder belt 16, or three or more feederbelts 16. The feeder belts 16 may be independent of one another, orconnected to one another in any suitable manner. A feeder belt 16 may berouted around each nose 50, where the noses 50 are laterally spaced fromone another and positioned on opposite sides of a knife, which isdescribed below. Each feeder belt 16 may be routed along a path thatstarts generally straight and in the distal direction, then is curvedalong the surface of the corresponding nose 50, and then is generallystraight and in the proximal direction. That is, the nose 50 changes thedirection of motion of the corresponding feeder belt 16 from generallydistal to generally proximal. Each nose 50 may be substantially as wideas the corresponding feeder belt 16 that moves along its surface.Alternately, at least one nose 50 may be narrower than, or wider than,the corresponding feeder belt 16. Alternately, the nose 50 may beomitted, where the feeder belt 16 is movable generally linearly.

At least one nose 50 may be bifurcated by a slot 52 defined therein. Theslot 52 may be oriented generally longitudinally. However, the slot 52may be defined in any other suitable orientation. Each feeder belt 16 ispositioned in contact with at least part of a corresponding nose 50,with staples 18 in each lateralmost row 26 of the feeder belt 16positioned laterally on either side of the nose 50. Where the feederbelt 16 includes a row 26 of staples 18 in the middle of that feederbelt, such as shown in FIG. 6, the slot 52 in the nose 50 may belaterally oriented in substantially the same position as the middle row26 of staples 18. In this way, the slot 52 provides space for thatmiddle row 26 of staples 18 to slide along. Alternately, at least onenose 50 may be divided into segments by two or more slots 52, dependingon the number of rows 26 of staples 18 attached to the correspondingfeeder belt 16. Alternately, the slot or slots 52 need not extend to thedistal end of the nose 50, because the staples 18 have been deployedfrom the corresponding segment of the feeder belt 16 by the time thatsegment of the feeder belt 16 reaches the nose 50, as described ingreater detail below. Alternately, at least one slot 52 may be omitted.At least one nose 50 may extend in the proximal direction any suitablelength. Similarly, the remainder of the feeder belt guide 40 may extendin the proximal direction any suitable length. The portion of the feederbelt guide 40 proximal to the distal end 42 may be referred to as theinsert 43. A knife slot 54 may extend along the length of the feederbelt guide 40, and may extend through the upper surface 44 of the distalend 42 of the feeder belt guide 40.

Referring also to FIG. 34, one or more pulleys 180 may be utilized inplace of the nose 50. The pulleys 180 may be generally circular inshape, or may be shaped in any other suitable manner. Each pulley 180may have a width substantially equal to or less than a correspondingfeeder belt 16. Optionally, at least one pulley 180 may be wider than acorresponding feeder belt 16, because staples 18 have been sheared orotherwise separated from the portion of the feeder belt 16 that contactsthe pulley 16, as set forth in greater detail below. Consequently, asingle pulley 180 may be used if desired, where that pulley 180 is atleast as wide as the distance between the lateralmost edges of thefeeder belts 16, taken collectively. Each pulley 180 rotates about anaxle 182. Referring also to FIG. 11, at least one aperture 184,depression, or other feature may be defined in the housing 60 near thedistal end thereof, such that the axle 182 is received therein. As oneexample, two apertures 184 are located in proximity to the distal end ofthe housing 60, and the axle 182 extends into both apertures 184. Theapertures 184 are oriented relative to the housing 60 such that the axle182 is in turn oriented generally perpendicular to the longitudinalcenterline of the housing 60. The axle 182 may be fixed to the housing60 at one or more apertures 184, or may be free to rotate relative tothe apertures 184. As another example, at least one pulley 180 is fixedto the axle 182, and the axle is allowed to rotate freely relative tothe apertures 184. Each pulley 180 advantageously may be an idler pulleythat acts to tension the corresponding feeder belt 16, and that rotatesfreely as the corresponding feeder belt 16 is advanced. The use of oneor more pulleys 180 advantageously reduces friction during advancementof the feeder belt 16, compared with the use of a fixed nose 50.

Referring to FIG. 11, a housing 60 is shown. The housing 60 may befabricated from a single piece of sheet metal. Alternately, the housing60 may be fabricated in any other suitable manner and/or from any othermaterial. The housing 60 may include a generally flat base 62, with twoouter walls 64 extending upward generally perpendicularly from the base62. The base 62 and outer walls 64 may be generally rectangular. Theouter walls 64 may be generally parallel to one another. Alternately,the base 62 and outer walls 64 may be shaped differently, and/ororiented differently relative to one another. A top plate 66 may extendgenerally laterally from the upper edge of each outer wall 64, such thatthe two top plates 66 generally lie in the same plane. Each top plate 66may be generally rectangular. A number of apertures 67 may be defined ineach top plate 66, where the apertures 67 allow for deployment ofstaples 18 therethrough. The two top plates 66 may be spaced apart fromone another along their length. An inner wall 68 extends generallydownward from the inner edge of each top plate 66, and may be generallyperpendicular to the corresponding top plate 66. Each inner wall 68 maybe generally rectangular, and the inner walls 68 may be spaced apartfrom and generally parallel to one another. However, at least one innerwall 68 may be shaped and/or oriented differently. The inner walls 68may be spaced apart far enough to allow a knife to pass between them, asdescribed in greater detail below. The lower edge of at least one innerwall 68 may contact the base 62, or may be spaced apart from the base62. A receiving space 70 is a volume in the housing created by the base62, outer wall 64, top plate 66 and inner wall 68. Two receiving spaces70 may be defined in the housing 60.

At least part of the housing 60 may omit the top plates 66 and/or innerwalls 68, such that at least part of the housing 60 is generallyU-shaped. The feeder belt guide 40 may be attached to the housing 60.This attachment may be accomplished in any suitable manner. As oneexample, the insert 43 portion of the feeder belt guide 40 may beinserted into one or more receiving spaces 70, then fixed thereto in anysuitable manner. As another example, the feeder belt guide 40 may notinclude an insert 43, and the feeder belt guide is attached to thedistal end of the housing 60 in any suitable manner. As another example,the feeder belt guide 40 may be fabricated integrally with the housing60. Alternately, the feeder belt guide 40 is not attached to or fixed tothe housing 60.

Referring also to FIG. 13, one or more wedge assemblies 72 extend intothe staple holder 30 of the end effector 4. Each wedge assembly 72 mayinclude a wedge 74 at the distal end of a arm 76. Alternately, the wedge74 may be positioned at a different location on the arm 76. The wedge 74may be shaped in any suitable manner. As one example, the upper surfaceof the wedge 74 may include a first surface 79 that may be angled orcurved upward, moving in the distal direction. The wedge 74 may alsoinclude a second surface 80 distal to the first surface 79, where thesecond surface may be angled or curved downward, moving in the distaldirection. The intersection between the first surface 79 and the secondsurface 80 may be a curved or smooth peak 82. Alternately, the peak 82may form an unsmoothed angle between the first surface 79 and the secondsurface 80. The lower surface of the wedge 74 may be substantiallylinear. Alternately, the lower surface of the wedge 74 may be curved,angled or otherwise shaped in any suitable manner. A tab 78 may beconnected to the proximal end of the arm 76. Alternately, the tab 78 maybe positioned at a different location on the arm 76. The tab 78 may besubstantially rectangular, or may be shaped in a different manner. Thetab 78 may extend in a downward direction from the arm 76, and the wedge74 may extend in an upward direction from the arm 76. Alternately, thewedge 74 and/or tab 78 are oriented differently relative to the arm 76.Advantageously, the wedge assembly 72 is fabricated as a single,integral structure. However, the wedge assembly 72 may be assembled fromseparate components, in any suitable manner. Referring to FIG. 12, eachwedge 74 may be initially positioned distal to a row 26 of staples 18,and may be generally longitudinally aligned with, and longitudinallymovable relative to, that corresponding row 26 of staples 18. The lengthof each wedge 74 may be equal to or less than the longitudinal spacingbetween staples 18 in a row 26, such that the wedge 74 deploys eachstaple 18 before moving into contact with the subsequent staple 18 inthe row 26. This configuration of wedge 74 is particularly useful wherethe length of the staple line is adjustable, because the deployment ofone staple 18 is independent of the deployment of any other staple 18.Alternately, the wedge 74 may be longer than the longitudinal spacingbetween staples 18 in a row 26, such that deployment of one staple 18concludes while the longitudinally-adjacent staple 18 is in the middleof deployment. Such a configuration of wedge 74 may be useful where thelength of the staple line is fixed, and a blank space is provided on thefeeder belt 16 between groups of staples 18 along a row 26.

Referring also to FIG. 14, the tab 78 of each wedge assembly 72 may beinserted into a receiving slot 86 in a block 84. Each receiving slot 86may be defined partially into, or completely through, the block 84. Thereceiving slot or slots 86 may be defined in the upper surface 88 of theblock 84, or in a different surface of the block 84. The receiving slotor slots 86 may be positioned at or near the distal end of the block 84,or at a different location on the block 84. Referring also to FIG. 15, aknife 90 may include a hook 92 at its proximal end. A pin 94 may extendlaterally across a knife receiving slot 96 defined in the distal end ofthe block 84, and the hook 92 may engage that pin 94. The pin 94 may begenerally cylindrical, or may have any other suitable shape for engagingthe hook. Alternately, the knife receiving slot 86 is defined in adifferent part of the block 84. Alternately, the hook 92 of the knife 90may be a tab similar to the tab 78 of the wedge assembly 72, and theknife receiving slot 86 may thus be configured in the same way as thereceiving slots 86 for the tabs 78 of the wedge assemblies 72.Alternately, the hook 92 may be shaped in any other suitable manner,such as a shape that is not a hook, and the knife receiving slot 96 maybe configured accordingly. Alternately, the receiving slots 86, knifereceiving slot 86 and/or tabs 78 may be omitted, and the wedgeassemblies 72 and/or knife 90 are connected to the block 84 in adifferent way, such as by molding. Alternately, the wedge assemblies 72,knife 90 and block 84 may be fabricated as an integral unit. The block84 may be generally shaped as a rectangular solid. Alternately, theblock 84 may be shaped in any other suitable manner. A protrusion 98 mayextend generally upward from the upper surface 88 of the block 84, at alocation at or near the proximal end of the block 84. Alternately, theprotrusion 98 may extend in a different direction and/or may extend froma different location on the block 84. The protrusion 98 may be generallyshaped as a rectangular solid, but may be shaped in any other suitablemanner. Alternately, the block 84 may be omitted, and the wedge assembly72 and knife 90 may be controlled and/or manipulated in any othersuitable manner.

At least part of the block 84 may be positioned in a space such as therecess 120 (FIG. 17A) defined within the end effector 4 and/or the shaft6, and the block 84 may be longitudinally slidable along that space inorder to control the motion of the wedge assemblies 72 and the knife 90.Alternately, the block 84 may be positioned differently relative to theend effector 4 and/or the shaft 6. Optionally, one or more sliders 100may extend downward from the lower surface 102 of the block 84 to engagea corresponding feature or features in the end effector 4 and/or shaft 6in order to facilitate sliding of the block 84. Alternately, the sliders100 may be omitted. Referring also to FIG. 16, a rod 104 may beconnected to the protrusion 98 in any suitable manner. As one example,the rod 104 may be molded into the protrusion 98. The distal end of therod 104 may be connected to the protrusion 98, and the rod 104 mayextend through the shaft 6 such that the proximal end of the rod 104extends into the handle 8. The rod 104 may be generally rigid, and mayextend generally longitudinally into the shaft 6 and/or through theshaft 6 to the handle 8. Alternately, the rod 104 may be flexible and/orthreaded, and the rod 104 may engage corresponding threads provided inthe protrusion 98 or other part of the block 84. In this way, rotationof the rod 104 causes the block 84 to advance or retract longitudinally.

Referring also to FIG. 15, the knife 90 may include a body 106 extendingin the distal direction from the hook 92. Like the arm 76 of a wedgeassembly 72, the body 106 of the knife 90 may be laterally thin, andlonger than it is wide or high. Alternately, the body 106, and/or atleast one arm 76, may be shaped differently. The body 106 may include acam surface 107 extending upward therefrom, at a location between theproximal and distal ends of the body 106. The cam surface 107 may beshaped in any suitable manner. As one example, the cam surface 107 mayextend gradually upward in the distal direction, then end at a verticalsurface substantially perpendicular to a portion of the body 106proximal to the cam surface 107. Referring also to FIG. 7A, the camsurface 107 may be shaped and sized to engage a corresponding feature200 defined on the surface of the anvil 32 in order to cam the knife 90away from the anvil 32 during at least part of the actuation of theendocutter 2 and/or the advancement of unfired staples 18 into firingposition, as described in greater detail below. A blade 108 may belocated at the distal end of the body 106. Advantageously, the knife 90may be fabricated as a single, integral structure. However, the knife 90may be assembled from a separate hook 92, body 106 and/or blade 108. Theblade 108 may be configured in any suitable manner for cutting tissue.As one example, the blade 108 includes a cutting edge 110 along itsupper edge, where that cutting edge 110 may be angled upward. movingproximally along the blade 108. Alternately, the cutting edge 110 may beoriented differently, or positioned differently on the blade 108.Referring also to FIG. 11, the knife 90 is movable along at least partof the space between the inner walls 68 of the housing 60. Part of eachfeeder belt 16 is positioned in each receiving space 70, laterallyoutward from the inner walls 68 of the housing 60. Thus, the knife 90 ismovable longitudinally between two feeder belts 16.

Optionally, the blade 108 and/or cutting edge 110 of the knife 90 may beheated in order to cauterize tissue. Optionally, an electric current maybe passed through the blade 108 of the knife 90 such that the blade 108electrically cauterizes tissue. The blade 108 may be unipolar, or may beone pole of a bipolar system. Optionally, the knife 90 may be omitted,and in its place a wire may be used. The wire may be threaded distallyinto the staple holder 30, upward from the staple holder 30 into theanvil 32, then proximally out of the anvil 32. Proximal motion of thewire causes the wire to move through tissue, cutting it. The wire may bean electrode, such that electricity may be applied to it to facilitateboth cutting and electrocauterization of tissue. The wire may be removedafter each use and a new wire advanced, in order for the end effector 4to be able to clamp another tissue structure, and to allow the wire tobe replaced each time to maximize its cutting and/or cauterizingability.

Referring also to FIG. 16, a cross-sectional view of the end effector 4in an initial configuration is shown. The blade 108 of the knife 90 maybe positioned entirely within the staple holder 30 in the initialconfiguration, to ensure that the cutting edge 110 does not incisetissue as the end effector 4 is moved to the surgical site. Further, theblade 108 may be positioned within the distal end 42 of the feeder beltguide 40 in the initial configuration. Alternately, the blade 108 may bepositioned differently. In the initial configuration, the staples 18 maybe positioned within the staple holder 30 in position for deployment,each located under a corresponding aperture 67 in the top plate 66. Theblock 84 is located in an initial position corresponding to the initialposition of the blade 108 and the wedge assemblies 72. Advantageously,in the initial configuration, the wedge assemblies 72 and the knife 90are each in their most-distal position. However, at least one wedgeassembly 72 and/or the knife 90 may be positioned differently in theinitial position.

Referring also to FIG. 17, a retainer 112 may be positioned between theend effector 4 to the shaft 6. Optionally, the retainer 112 may providea connection between the end effector 4 and the shaft 6, such as byfriction or interference fitting with both the end effector 4 and theshaft 6, or by otherwise connecting both the end effector 4 and theshaft 6 to the retainer 112. Alternately, the retainer 112 may bepositioned entirely within the end effector 4. The retainer 112 may beshaped in any suitable manner. The retainer 112 may include an extension114 protruding distally from a first body segment 118, where theextension 114 includes a ramp 116 at the distal end thereof. The ramp116 may be angled upward in the proximal direction. The ramp 116 may begenerally linear. Alternately, the ramp 116 may be oriented differently,and may be curved or otherwise shaped. The first body segment 118 may beshaped and sized to be received in the proximal end of the housing 60,and at least part of the first body segment 118 may extend into theproximal end of at least one receiving space 70 of the housing 60. Thefirst body segment 118 may be fixed to the housing 60, such as bypressure or interference fitting, by adhesive, by welding, or by anyother suitable mechanism or method. Alternately, the first body segment118 is not fixed to the housing 60. Alternately, the retainer 112 is notfixed or connected to the housing 60. Alternately, the retainer 112 maybe omitted. Optionally, at least part of the feeder belt guide 40 may beconnected to the retainer 112 as well. As one example, the insert 43 ofthe feeder belt guide 40 may extend completely through a receiving space70 in the housing 60 and into contact with the retainer 112. If so, thefeeder belt guide 40 may be connected to the retainer 112 in anysuitable manner.

Referring also to FIG. 17A, the underside of the retainer 112 mayinclude a recess 120 defined therein. The recess 120 may be shaped andsized to allow the block 84 to slide therein. The recess 120 may includea slot 122 defined therethrough, where the slot 122 may receive theprotrusion 98 and allow the protrusion 98 to slide therein. The recess120 and/or slot 122 may guide the motion of the block 84 longitudinallyand restrict motion of the block 84 proximal or distal to certainlocations, and may also or instead restrict lateral motion of the block84. For example, the recess 120 may include a distal wall 124 thatcontacts the distal end of the block 84 when the block 84 has advanceddistally as far as desired, and a proximal wall 126 that contacts theproximal end of the block 84 when the block 84 has retracted proximallyas far as desired. Alternately, the recess 120 may be defined in adifferent part of the retainer 112, or may be omitted.

Referring to FIG. 30, optionally sliding clamps 160 may be provided,where each set of sliding clamps 160 may be associated with acorresponding feeder belt 16. Each set of sliding clamps 160 may includean upper clamp 162 and a lower clamp 164, where at least one of theclamps 162, 164 is slidable relative to the other. The lower clamp 164may have a slot 166 defined generally longitudinally therein andoriented generally upward. The upper clamp 162 may have a tongue 168oriented generally downward, where the tongue 168 is sized andconfigured to be received in the slot 166 in the lower clamp 164. Thetongue 168 may be narrower than the remainder of the upper clamp 162, ormay be sized in any other suitable manner. The wider area of the upperclamp 162 from which the tongue 168 extends forms a ledge 169 at itslower surface. The upper surface of the upper clamp 162 may besubstantially as wide as the feeder belt 16.

Referring also to FIG. 31, initially the distal end of the upper clamp162 may extend further in the distal direction than the distal end ofthe lower clamp 164. Alternately, the distal end of the lower clamp 164initially may extend further in the distal direction than the distal endof the upper clamp 162. Alternately, initially the distal ends of eachclamp 162, 164 may extend substantially the same distance in the distaldirection. The upper surface of the lower clamp 164 may have a camsurface 170 defined thereon. Similarly, the ledge 169 of the upper clamp162 may be shaped to define a cam surface 172 thereon. The two camsurfaces 170, 172 engage one another such that, in the initial positionof the two clamps 162, 164, the height of the upper clamp 162 is lowerthan the height of the upper portion of the corresponding feeder belt16; as a result, the feeder belt 16 can be advanced without beingrestrained by the upper clamp 162. Referring also to FIGS. 32-33, thecam surfaces 170, 172 are shaped such that, as the upper clamp 162 isretracted proximally and/or the lower clamp 164 is advanced distally,the upper clamp 162 is pushed upward into contact with the feeder belt16. Such contact provides additional support for the feeder belt 16during deployment of the staples 18.

Referring also to FIGS. 34 and 44, each feeder belt 16 may be associatedwith a single clamp 161. Each clamp 161 may be generally rectangular inshape. The upper surface of each clamp 161 may be substantially as wideas the corresponding feeder belt 16. Each clamp 161 may be locatedslightly proximal to the nose 50 or pulleys 180, or may be positioneddifferently. Each clamp 161 may include at least one tab 322 extendingdownward. Referring also to FIG. 44, a plurality of slots 324 may extendthrough the base 62 of the housing 60, where each slot 324 correspondsto the initial, unclamped location of a tab 322 of the correspondingclamp 161. Each tab 322 may be sized to enter the corresponding slot 324substantially completely, before the feeder belt 16 is clamped.Optionally, the distal end of at least one slot 324 may include a ramp327 sloping upward in the distal direction. Similarly, the distal end ofat least one tab 32 may include a ramp 328 sloping upward in the distaldirection. Referring also to FIG. 45, each clamp 161 may be fixed orotherwise coupled to the overtube 236, such that distal motion of theovertube 236 urges the clamps 161 distally to a clamped position, andsuch that proximal motion of the overtube 236 urges the clamps 161proximally to an unclamped position. As one example, each clamp 161 mayinclude a connector block 330 at its proximal end, or at any othersuitable location. Both clamps 161 may be connected to the sameconnector block 330. Each connector block 330 may be fixed to theovertube 236 in any suitable manner. As one example, the overtube 236may include an aperture between two spaced-apart bent-inward tabs 332 ofthe wall of the overtube 236. The overtube 236 may be cut, such as bylaser cutting, to form the aperture and to form the tabs 332. The tabs332 may be bent inward a sufficient amount to hold the connector block330 therebetween during motion of the overtube 236. Alternately, theclamps 161 may be fixed or otherwise coupled to the overtube 236 in anyother suitable manner.

Endocutter—Two Staple Rows

Referring also to FIG. 6, the endocutter 2 described above includes anend effector 4 configured to place two or more sets of three rows 26 ofstaples 18. However, the end effector 4 may be configured to place twoor more sets of different numbers of rows 26 of staples 18, such as bychanging the number of rows 26 of staples 18 on the one or more feederbelts 16. Such an end effector 4 may be configured generally asdescribed above. As one example, referring to FIGS. 18-20, a feeder belt16 may include two rows 26 of staples 18. With such a feeder belt 16,one row 26 of staples 18 may be located along each side of the feederbelt 16. As a result, the feeder belt 16 may be narrower than a feederbelt 16 in which a third row 26 of staples 18 extends along the centerportion of the feeder belt 16. Thus, by reducing the number of rows 26of staples 18, the end effector 4 may be reduced in size. For example,the end effector 4 described above as having three rows 26 of staples 18may be sized to fit through a trocar port 10 having a 10 mm diameterpassage therethrough, and an end effector 4 having two rows 26 ofstaples 18 may be sized to fit through a trocar port 10 having a 5 mmdiameter passage therethrough. Referring to FIGS. 18-20, the staples 18may be shaped, and positioned relative to the feeder belt 16,substantially as described above with regard to the feeder belt 16having three rows 26 of staples 18. Alternately, the staples 18 may beshaped differently and/or positioned in any other suitable mannerrelative to the feeder belt 16. The staples 18 may be frangiblyconnected to the feeder belt 16 substantially as described above.Alternately, the staples 18 may be connected to the feeder belt 16 inany other suitable manner.

At least two staples 18 in different rows 26 may be staggered relativeto one another. That is, at a given longitudinal position along thefeeder belt 16 at which a staple 18 in one row 26 is attached to thefeeder belt 16, the other row 26 does not have a staple 18 attached tothe feeder belt 16. This staggering of the staples 18 promoteshemostasis in tissue treated with the end effector 4. Alternately,staples 18 in each row 26 may be aligned with one another, such that ata given longitudinal position along the feeder belt 16 at which a staple18 in one row 26 is connected to the feeder belt 16, each other row 26has a staple 18 connected to the feeder belt 16 as well.

The staples 18 in each row 26 may be substantially evenly spaced apartfrom one another. That is, the distance between any twolongitudinally-adjacent staples 18 in a row is substantially the same.Alternately, at least two longitudinally-adjacent staples 18 in each row26 may be spaced apart a distance different from the distance betweentwo other longitudinally-adjacent staples 18. Such a configuration maybe useful where the length of the staple line is not adjustable. Thestaple line to be created with the end effector 4 may be fixed at aparticular number of staples 18, and the staples 18 in each row may begrouped together in groups each having a length substantially the sameas that fixed staple line. Each group of staples 18 in a row 26 may thusbe separated from the adjacent group of staples 18 by a blank space onthe feeder belt 16, where that blank space may have any suitable length.

Referring to FIG. 21, the configuration of the end effector 4 utilizingfeeder belts 16 each having two rows 26 of staples 18 is similar to theconfiguration of the end effector 4 utilizing feeder belts 16 eachhaving three rows 26 of staples 18, as shown in FIG. 16. Referring toFIG. 22, the housing 60 may be configured similarly to the housing ofFIG. 11. The housing 60 includes two rows of apertures 67 in each topplate 66, corresponding to the two rows 26 of staples 18 of each feederbelt 16. Due to the presence of two, rather than three, rows ofapertures 67 in each top plate 66, the top plates 66 and thus thehousing 60 overall may be narrower than the housing of FIG. 16.Optionally, at least part of the housing 60 may omit the top plates 66and/or inner walls 68. Referring to FIGS. 23 and 24, the block 84optionally may be configured differently than the block 84 of FIG. 14,in order to fit within a narrower end effector 4. The projection 98 maybe longer in the longitudinal direction than the projection 98 of theblock 84 of FIG. 14. The distal end or other portion of the rod 104 maybe attached to the protrusion 98 in any suitable manner. As one example,the rod 104 may be molded into the protrusion 98. A riser 130 may extendupward from the upper surface 88 of the block 84, where a knifereceiving slot 96 may be defined generally longitudinally in the riser130. The riser 130 may be generally triangular, or may be any othersuitable shape. Optionally, the riser 130 may be connected to or part ofthe protrusion 98 that engages the rod 104. A pin 94 may extendlaterally across the knife receiving slot 96 of the riser 130, andengages the hook 92 at the proximal end of the knife 90. Alternately,the block 84 may be omitted.

Two receiving slots 86 may be defined partially into, or completelythrough, the block 84, generally as described with regard to FIG. 14above. Referring also to FIG. 23A, another example of a wedge assembly72 is shown. The wedge assembly 72 includes a tab 78 and an arm 76, aswith the wedge assembly 72 of FIG. 14. However, the wedge assembly 72 ofFIG. 23A includes two or more wedges 74 at its distal end, where thewedges 74 may be spaced apart laterally from one another and may begenerally parallel to one another. In this way, multiple wedges 74 canbe controller by a single arm 76, reducing the number of parts needed inthe end effector 4 and allowing the end effector 4 to be made narrower.The wedges 74 may be shaped as set forth with regard to FIG. 14, or maybe shaped in any other suitable manner. The tab 78 of each wedgeassembly 72 of FIG. 23A may be inserted into a corresponding receivingslot 86 in the block 84 of FIG. 23. Alternately, four receiving slots 86may be provided in the block 84 of FIG. 23, and the wedge assemblies 72of FIG. 14 may be used. Alternately, the block 84 may be configuredgenerally as described above and shown in FIG. 14.

Two exemplary embodiments of the end effector 4 have been describedabove, and in each one the end effector 4 places two sets of rows 26 ofstaples 18. However, the end effector 4 may be configured to place oneset, or three or more sets, of rows 26 of staples 18. Further, thefeeder belt 16 may be configured to place any desired number of rows 26of staples 18 within a given set of rows 26. Further, any number offeeder belts 16 may be placed on either side of the knife 90. The numberof feeder belts 16 on one side of the knife 90 may be the same as, ordifferent from, the number of feeder belts 16 on the other side of theknife 90. The number of feeder belts 16 utilized may be related to thetype of tissue that is treated by the end effector 4. The number of rows26 of staples 18 may be different on each feeder belt 16, or may be thesame on each feeder belt 16. The number of rows 26 of staples 18 on anindividual feeder belt 16 may vary along the length of that feeder belt16, or may be constant. As another example of an end effector 4, theknife 90 may be omitted, such that the end effector 4 is simply astapler that does not cut tissue. If so, any suitable number of feederbelts 16 may be utilized.

Referring to FIGS. 25-27, another exemplary feeder belt 16 having tworows 26 of staples 18 is shown. This feeder belt 16 may include aplurality of openings 132 defined therein or therethrough. The openings132 may be round, or any other suitable shape. The openings may all beof substantially the same size and/or shape, and/or may be of differentsizes and/or shapes. The openings 132 may be useful in reducing themoment of inertia of the feeder belt 16 such that the feeder belt 16 ismore flexible and more easily slides along the nose 50 of the stapleholder 30. Instead, or in addition, one or more of the openings 132 maybe engaged by pins or gears (not shown) in the handle 8 of theendocutter 2 in order to cause the feeder belt 16 to move. In additionto, or instead of, the openings 132, the feeder belt 16 may have one ormore notches 134 defined in one or more lateral edges thereof. Eachnotch 134 may be located adjacent to a tab 28, or one or more notches134 may be located differently. The notches 134 also may act to increasethe flexibility of the feeder belt 16, and/or to promote engagementbetween a mechanism in the handle 8 and the feeder belt 16.

At least one staple 18 may be shaped as a continuous curve, as may bemost clearly seen in FIG. 26. A distal end of the staple 18 may beconnected to the feeder belt 16, such as via a tab 28 protrudinglaterally from the feeder belt 16, such as described above. The staple18 may extend proximally and downward from the tab 28. Then, the staple18 may continue to curve downward, but also curve distally to form abump 136. This bump 136 may extend to the longitudinal position of thetab 28, further distally than the longitudinal position of the tab 28,or not as far longitudinally as the tab 28. Then, the staple 18 maycontinue to curve downward, but also curve proximally. The staple 18continues to curve proximally, then begins to curve upward at aninflection point 138. The staple 18 then continues to curve upward andproximally until terminating at a free end 22 at its proximal end.

Referring also to FIG. 35, another exemplary feeder belt 16 connected totwo rows of staples 18 is shown. The feeder belt 16 may include openingstherethrough as described above with regard to FIGS. 25-27, or may omitsuch openings. One or more staples 18 connected to the feeder belt 16 ofFIG. 35 may include a distal leg 194 and a proximal leg 196 connected tothe distal leg 194. The distal leg 194 may be oriented generallyperpendicular to the longitudinal centerline of the feeder belt 16, andthe proximal end of the proximal leg 196 may be oriented generallyperpendicular to the longitudinal centerline of the feeder belt 16. Theproximal leg 196 may curve downward in the distal direction toward itsconnection to the distal leg 194. Alternately, the distal leg 194 and/prthe proximal end of the proximal leg 196 of the staple 18 may beoriented differently. The distal leg 196 may include a protrusion 198extending therefrom. The protrusion 198 may be located below theconnection between the proximal leg 196 and the feeder belt 16, and mayextend in the proximal direction. The protrusion 198 may extend alongpart of or substantially all of the distal leg 194. The protrusion 198facilitates closure of the staple 18 during deployment, as described ingreater detail below. The connection between the distal leg 194 of astaple 18 and the feeder belt 16 may be coined, in order to facilitateseparation between the staple 18 and the feeder belt 16 after closure ofthe staple 18. However, the distal leg 194 of at least one staple 18 maybe connected to the corresponding feeder belt 16 in any other suitablemanner. The feeder belt 16 and associated staples 18 may be fabricatedin any suitable manner. As one example, the feeder belt 16 and staples18 may be stamped from a sheet of stainless steel or other metal. Thejunction between at least one staple 18 and the feeder belt 16 may becoined, and the staples 18 then may be bent substantially ninety degreesrelative to the feeder belt 16.

Referring also to FIGS. 28-28A, the wedge 74 of a wedge assembly 72 mayhave a shape that facilitates deployment of the staples of FIGS. 25-27.The wedge 74 may have a first segment 140 shaped to facilitatedeployment of the staple 18, and a second segment 142 shaped tofacilitate shearing or otherwise separating the staple 18 from thefeeder belt 16. The first segment 140 is curved upward and distally; thecurve may have any shape that facilitates formation of a staple 18. Byproviding two distinct segments 140, 142 on the wedge 74, formation andseparation of the staple 18 can be separately controlled, as describedin greater detail below. Referring to FIG. 28, the wedge 74 may includea first ramp 186 extending upward in the distal direction at a firstangle relative to the longitudinal centerline of the arm 76. The wedge74 may include a second ramp 188 extending upward in the distaldirection from the distal end of the first ramp 186, at a second anglerelative to the longitudinal centerline of the arm 76. The second anglemay be more acute than the first angle. The first segment 140 of thewedge 74 may extend longitudinally along substantially the length of thesecond ramp 188, because contact between the second ramp 188 and astaple 18 closes the staple 18, as described in greater detail below.The wedge 74 may include a spacer segment 190 extending distally fromthe distal end of the second ramp 188, substantially parallel to andspaced apart from the longitudinal centerline of the arm 76.Alternately, the spacer segment 190 may be oriented in a differentdirection. The wedge 74 may include a third ramp 192 extending distallyfrom the distal end of the spacer segment 190, extending upward in thedistal direction at a third angle relative to the longitudinalcenterline of the arm 76. The second segment 142 of the wedge 74 mayextend longitudinally along substantially the length of the third ramp192, because contact between the third ramp 192 and a staple 18 shearsor otherwise separates the staple 18 from the corresponding feeder belt16, as described in greater detail below.

Handle

Referring to FIGS. 37-38, the handle 8 may include a housing 214 thatprotects at least some of the components of the handle 8, and thatdefines a space 221 therein for those components. The housing 214 mayinclude a heel 216 of a trigger grip, which may be configured to rest ina surgeon's palm during use. The housing 214 may include an axle 218defined therein, extending into the space 221 within the housing 214.Advantageously, the axle 218 spans the space 221 such that each end isconnected to the housing 214. Two different triggers may be rotatablymounted on the axle 218. A clamping trigger 220 may be rotatably mountedon the axle 218. As one example, an aperture 224 may be defined througha portion of the clamping trigger 220, such that the axle 218 isreceived within the aperture 224. A firing trigger 222 may be rotatablymounted on the axle 218 as well. As one example, the firing trigger 222may include a head portion 226 that includes two laterally-spaced sidewalls 228 spaced far enough apart from one another such that the portionof the clamping trigger 220 adjacent to the aperture 224 can fit betweenthe side walls 228. Each side wall 228 may include a head aperture 230defined therein, such that the axle 218 is received within that aperture224.

The clamping trigger 220 includes a grip portion 232 configured for asurgeon to grasp, where that grip portion 232 is on one side of theaperture 224. On another side of the aperture 224, the clamping trigger220 includes a clamp arm 234. The clamp arm 234 may be sized and shapedin any suitable manner. The clamp arm 234 may be configured to engage anovertube 236, in any suitable manner. As one example, the overtube 236includes a curved engagement feature 238 defined in a surface thereof.The clamp arm 234 may be curved or rounded at its free end in order tosmoothly engage the engagement feature 238 of the overtube 236 as theclamp arm 234 is rotated about the axle 218. The engagement feature 238may have a radius of curvature slightly less than the distance betweenthe axle 218 and the free end of the clamp arm 234, such that contactbetween the clamp arm 234 and the engagement feature 238 results in anamount of frictional force sufficient to advance the overtube 236. Thehead portion 226 of the firing trigger 222 may include a notch 256defined therein through which the clamp arm 234 extends into contactwith the engagement feature 238. The overtube 236 extends distally outof the housing 214, and may include a lumen through which at least partof the shaft 6 extends. The overtube 236 extends to a position slightlydistal to the anvil 32 prior to clamping, such that advancement of theovertube 236 causes the anvil 32 to close, as described in greaterdetail below.

The overtube 236 may be biased in the proximal direction, such as by acoil spring (not shown) connected to both the overtube 236 and thehousing, or in any other suitable manner. A button 240 may be includedas a component of the handle 8, where the button 240 is rotatable abouta button axle 242 extending from the housing 214. The button 240 mayinclude a stop arm 244 that extends into the proximal end of theovertube 236. The button 240 may include a finger pad 248 angularlyspaced from the stop arm 248, where the button 240 may extend out of theproximal end of the housing 216. A tab 250 may also be angularly spacedfrom the stop arm 244, where a coil spring 252 or other biasing elementmay be fixed to or placed adjacent to that tab 250. The tab 250 may beoriented toward a pocket 254 in the housing 214, whereby the pocket 254holds the spring 252 in place. The proximal end of the overtube 236 mayinclude a stop wall 249 extending upward from a lower surface in thelumen 240 of the overtube 236. As the overtube 236 advances, the stoparm 244 of the button drops into place proximal to the stop wall 249 ofthe overtube 236, preventing the overtube 236 from moving proximally,and locking the overtube 236 in place. The stop arm 244 may drop intoplace proximal to the stop wall 249 as a result of gravity pulling thatstop arm 244 downward, or the stop arm 244 may be biased downward by thecompressive force of the spring 252 or other mechanism. As used in thisdocument, terms such as “upward,” “downward” and “lateral” refer tolocal directions with regard to the drawings and are used forconvenience and clarity; such terms do not limit the orientation of theendocutter 2 in use.

The firing trigger 222 includes a grip portion 258 configured for asurgeon to grasp, where that grip portion 258 is on one side of the headaperture 230. The head portion 226 of the firing trigger 222 includesteeth 260 defined thereon, and a tab 262 angularly spaced apart from theteeth 260. The firing trigger 222 is biased toward an initial position,such as by a coil spring (not shown) attached to a return pin 284 and tothe housing 216. The return pin 284 may be connected to the firingtrigger 222 at a location on the head portion 226 or any other suitableportion of the firing trigger 222. The force of the spring or otherbiasing member on the return pin 284 creates a moment about the axle 218that urges the firing trigger 222 outward to an initial pre-firingposition.

A transmission member 270 may be located within the space 221 within thehousing 216, and may include a first rack 272 and a second rack 274defined thereon. Each of the first rack 272 and the second rack 274include teeth. The first rack 272 includes teeth configured to engagecorresponding teeth 260 of the head portion 226 of the firing trigger222. The transmission member 270 may have any suitable shape. As oneexample, the transmission member 270 may include a proximal arm 276 fromwhich the first rack 272 extends downward, and a distal arm 278 fromwhich the second rack 274 extends upward. The distal arm 278 may belocated lower than the proximal arm 276, such that the proximal end ofthe distal arm 278 forms a wall 280. As the firing trigger 222 isactuated, the head portion 226 rotates about the axle 218. Such rotationcauses the teeth 260 and tab 262 attached to the head portion 226 torotate about the axle 218 as well. The tab 262 may initially bepositioned adjacent to the distal end of the first rack 272. The distalend of the first rack 272 may include a stop 282 that engages the tab262 and prevents the tab 262 from moving further proximally. The firstrack 272 may be located proximal to, and spaced apart from, the wall 280of the transmission. Thus, as the head portion 226 rotates about theaxle 218, the tab 262 moves away from the first rack 272 and then intoengagement with the wall 280 of the transmission 270. The space betweenthe first rack 272 and the wall 280 of the transmission provides asafety margin to the firing trigger 222, such that the endocutter 2 isnot inadvertently actuated with only a small input to the firing trigger222. Further rotation of the head portion 226 of the firing trigger 222causes the tab 262 to urge the wall 280 of the transmission 270distally, thereby moving the transmission 270 as a whole distally. Thisdistal motion moves the first rack 272 into contact with the teeth 260of the head portion 226 of the firing member 222. As a result, furtherrotation of the head portion 226 causes the teeth 260 of the headportion 226 to engage the first rack 272 and move the transmission 270further distally. The overtube 236 may include one or more guidefeatures 237 defined in the lumen 241 thereof to guide and/or constrainthe motion of the transmission 270. As one example, a guide feature 237may be a generally horizontal tab positioned above and substantially incontact with an upper surface of the transmission 270. Further, thehousing 214 may guide and/or constrain the motion of the transmission270. As one example, the distal end of the transmission 270 may bevertically constrained between the gear 286 described below and aportion of the housing 214.

The second rack 274 of the transmission 270 is configured to engage agear 286 that has two separate sets of teeth. The second rack 274 of thetransmission 280 engages the first set of teeth 288 of the gear 286,where the first set of teeth 288 form a circular gear having a firstdiameter. The second set of teeth 290 form a circular gear having asecond diameter larger than the first diameter. Alternately, the teeth288, 290 may be located on separate gears fixed to one another, ratherthan on a single gear 286. As the transmission 270 moves distally, thesecond rack 274 moves distally, engaging the first set of teeth 288 ofthe gear 286 and causing the gear 286 to rotate. Such rotation in turncauses the second set of teeth 290 to rotate as well. Referring as wellto FIG. 39, a driver rack 294 includes teeth 296 that are configured toengage the second set of teeth 290 of the gear 286. During actuation ofthe firing trigger 222, the gear 286 rotates in a direction such thatinteraction between the second set of teeth 290 of the gear 286 and theteeth 296 of the driver rack 294 urges the driver rack 294 proximally.Referring to FIGS. 39-40, the driver rack 294 may be fixed to a driver300 that extends through the shaft 6 to the end effector 4. The driver300 may include an elongated arm 302 that may have a circular,rectangular, or other suitable cross-section. The elongated arm 302 maybe connected to the driver rack 294, and may be fixed to the driver rack294 in any suitable manner. As one example, the driver rack 294 mayinclude a generally T-shaped passage 304 defined in proximity to thedistal end thereof. The T-shaped passage 304 is advantageously open atits distal end, thereby creating an opening 308 at the distal end of thedriver rack 294. The opening 308 may be generally rectangular. Thepassage 304 may be oriented in any suitable direction, such as generallylaterally. The elongated arm 302 may include a generally circular button306 at its proximal end, with a thin extension bar 310 connecting thebutton 306 to a remainder of the elongated arm 302. The button 306 maybe substantially as thick as the T-shaped passage 304, such that thebutton 306 may slide into and frictionally engage the T-shaped passage304. The button 306 may be additionally fixed to the driver rack 294 byadhesive, welding and/or any other suitable method and/or mechanism. Thebar 310 is sized to slide into the opening 308 of the T-shaped passage304 as the button 306 enters the T-shaped passage.

Referring also to FIGS. 42 and 47, moving distally along the elongatedarm 302 of the driver 300, a depression 312 may be defined in the uppersurface of the elongated arm 302. The depression 312 extends along aportion of the elongated arm 302. A pawl 314 may be located at thedistal end of the depression 312. The pawl 314 may be oriented generallyproximally and generally parallel to the longitudinal centerline of theelongated arm 302, such that it is cantilevered over a distal portion ofthe depression 312. Because the pawl 314 is cantilevered over a portionof the depression 312, it is flexible downward into the depression 312,and may be biased upward in the direction out of the depression 312.Alternately, the pawl 314 may be configured differently. The pawl 314may include an upward-extending stop 316 in proximity to its proximalend, with a ramp 318 extending proximally and downward from the upperend of the stop 316.

Moving distally along the elongated arm 302 of the driver 300, referringalso to FIG. 43, the distal end of the elongated arm 302 may beconnected to a plate 320 that in turn is connected to a plurality ofwedge assemblies 72. Alternately, the elongated arm 302 may be connecteddirectly to at least one wedge assembly 72. Alternately, a differentportion of the elongated arm 302 may be connected to the wedgeassemblies 72, directly or indirectly. The number of wedge assemblies 72corresponds to the number of staple rows deployed by the end effector 4.The plate 320 may be welded, adhered to, fabricated integrally with, orotherwise positioned on the underside of the distal end of the elongatedarm 302. Each wedge assembly 72 may be connected to the plate 320 in anysuitable manner. As one example, each wedge assembly 72 may include atab 78 at or near its proximal end such as seen in FIG. 13, where thattab 78 is configured to be received in a receiving slot in the plate 320that may be configured in a similar manner as the receiving slot 86 seenin FIG. 14. Advantageously, the wedge assemblies 72 are fixed to theplate 320 in any suitable manner, such as by welding, adhesive, frictionfitting, interference fitting, and/or any other suitable methods ormechanisms. Referring back to FIG. 43, at least one wedge 74 may bestaggered relative to one or more other wedges 74. That is, at least onewedge 74 may be positioned at a distance from the distal end of theelongated arm 302 different from that of at least one other wedge 74. Asa result, where at least one wedge 74 is staggered, the wedges 74 arenot laterally aligned relative to one another. As another example, thewedges 74 need not be staggered, and each wedge 74 may be positioned atsubstantially the same distance from the distal end of the elongated arm302. As a result, where the wedges 74 are not staggered, the wedges aresubstantially laterally aligned relative to one another.

The driver 300 includes the wedge assemblies 72, the elongated arm 302,the button 306, and the bar 310. Where the driver 300 of FIG. 43 isutilized, the wedges 74 may be positioned and oriented relative to thestaple holder 30 substantially as described above, such as with regardto FIGS. 11 and 13. Referring also to FIG. 36, the proximal end of theknife 90 may be connected to the driver 300, such as at the plate 320 orthe distal end of the elongated arm 302. As one example, a knife axle301 is located at the distal end of the elongated arm 302, and the hook92 of the knife 90 engages that knife axle 301 in any suitable manner.Advantageously, the knife 90 is fixed to the knife axle 301, such as bywelding.

Referring to FIG. 40, a top plate 340 may extend above the driver rack294, without being connected to the driver rack 294. The top plate 340may be generally elongated. Referring also to FIG. 46, the top plate 340may include one or more ratchet ramps 342 extending downward from anunderside thereof. Each ratchet ramp 342 may extend substantially alonga center portion of the underside of the top plate 340, spaced apartfrom both lateral edges of the top plate 340. Advantageously, theratchet ramps 342 may be spaced substantially equidistant from thelateral edges of the top plate 340. Each ratchet ramp 342 extendsdownward in the proximal direction, and may be straight, curved orotherwise shaped. Alternately, at least one ratchet ramp 342 may beshaped or oriented differently. At the proximal end of each ratchet ramp342, a face 344 may extend upward toward a remainder of the top plate340. The face 344 may be oriented generally vertically, or may beoriented in any other suitable direction. Where multiple ratchet ramps342 are utilized, another ratchet ramp 342 may begin immediatelyproximal to the face 344, or may begin at a location spaced apart fromthe face 344. A top plate rack 346 may be located on the underside ofthe top plate 340, lateral to the ratchet ramps 342, and advantageouslylocated on both sides of the ratchet ramps 342.

Referring also to FIG. 47, the top plate rack 346 includes multiple gearteeth 348 configured to engage one or more spur gears 350. Where the topplate rack 346 includes two sets of gear teeth 348 laterally separatedby the ratchet ramp or ramps 342, two spur gears 350 may be used, oneconfigured to engage each set of gear teeth 348. The spur gears 350 maybe connected to one another by an axle 352, forming a spur gear assembly354. The spur gears 350 may be held in place in any suitable manner. Asone example, the retainer 112 includes a niche 356 in which the spurgears 350 are held. The niche 356 may include one or more apertures 358or depressions each configured to hold an end of the axle 352. The spurgear or gears 350 are advantageously idler gears that are not activelydriven. However, at least one spur gear 350 may be actively driven ifdesired.

Referring to FIG. 40, the distal end of the top plate 340 may be fixedor otherwise connected to an end of a corresponding feeder belt 16 inany suitable manner, such as by welding. The other end of the feederbelt 16 may be fixed or otherwise connected to a bottom plate 360 in anysuitable manner such as by welding. The bottom plate 360 includes abottom plate rack 362 including gear teeth oriented generally upward.The bottom plate 360 may be thin, and generally elongated. The bottomplate 360 may be generally parallel to the top plate 340. The gear teethof the bottom plate rack 362 of the bottom plate 360 are configured toengage the one or more spur gears 350. Consequently, motion of the topplate 340 and bottom plate 360 are coupled in the opposite direction toone another, as described in greater detail below.

Operation

Referring to FIGS. 2-3, at least one trocar port 10 is inserted into anopening in tissue 12 of a patient 14. Where a trocar port 10 includes acutting tool (not shown) such as a spike, that cutting tool makes anopening in tissue 12, after which the trocar port 12 is placed intissue. The cutting tool may be removed from the trocar port 10 afterthe trocar port 10 is in position in tissue 12. Alternately, an openingin tissue 12 may be made first with a separate tool, and the trocar port10 is then placed in that opening. Multiple trocar ports 10, having thesame or different cross-sectional shapes and/or areas, may be placed inthe patient 14. The tissue 12 may be the chest wall of the patient 14,thereby providing access to the thoracic cavity. However, the tissue 12may be the abdominal wall or any other suitable tissue in the patient14. Alternately, the trocar port or ports 10 are not used, and access tothe surgical site is gained in another manner, such as described above.

Referring also to FIGS. 1, 16 and 21, the end effector 4 of theendocutter 2 is introduced into the patient 14 through one of the trocarports 10. At least part of the shaft 6 of the endocutter 2 may followthe end effector 4 into the patient 14. Alternately, the trocar port orports 10 are not used, and the endocutter 2 is used during aconventional open surgical procedure or is introduced into the patient14 directly through an incision in tissue 12. The end effector 4 ispositioned by the user at a surgical site. As one example, referringalso to FIG. 29, a surgical site is located on a blood vessel 148 whichis to be transected. For clarity, this document describes the operationof the endocutter 2 for transection of a blood vessel 148. However, theuse of the endocutter 2 is not limited to blood vessel transection; theendocutter 2 may be used to perform any other suitable procedure at anyother surgical site in the body. For example, the endocutter 2 may beused to transect a bile duct, to remove a diseased appendix, to transectgastrointestinal tissue, and/or to transect soft tissue or organs.

Referring to FIGS. 16 and 21, at least the distal end of the anvil 32 isinitially spaced apart from the staple holder 30, such that the endeffector 4 is open. The end effector 4 is advanced over the blood vessel148 to be transected, until the entire diameter of the blood vessel 148is located between the anvil 32 and the staple holder 30.Advantageously, the blood vessel 148 is substantially at a right angleto the anvil 32 and the staple holder 30. However, the blood vessel 148may be oriented at any other suitable angle relative to the anvil 32 andthe staple holder 30. The end effector 4 is then closed, by moving theanvil 32 closer to the staple holder 30, such that the blood vessel 148is compressed between the anvil 32 and the staple holder 30. Suchclosure of the end effector 4 may be accomplished in any standard manneror any other suitable manner. As one example, referring to FIGS. 37-38,the clamping trigger 220 is compressed toward the heel 216 of thehousing 214 of the handle 8. As set forth above, as the clamping trigger220 is compressed toward the heel 216 of the housing 216, the clamp arm234 rotates about the axle 218 in the housing 214. This rotation causesthe free end of the clamp arm 234 to move partially in the distaldirection. The clamp arm 234 engages the overtube 236 during itsrotation, and in turn urges the overtube 236 to advance distally. As aresult, the overtube 236 advances distally toward the anvil 32 and thestaple holder 30. As the overtube 236 advances distally, the proximalends of both the anvil 32 and the staple holder 30 enter the lumen 241of the overtube 236. As the overtube 236 continues to advance, contactbetween the distal end of the overtube 236 urges the anvil 32 and stapleholder 30 toward one another. The overtube 236 continues to advancedistally until the anvil 32 and staple holder 30 have moved together toa final, closed position. The overtube 236 may be used to close the endeffector 4 whether the anvil 32 or staple holder 30, or neither, aresubstantially fixed relative to a remainder of the end effector 4 and/orthe shaft 6. The use of an overtube to close an anvil 32 and stapleholder 30 is standard in the art. After the end effector 4 has beenclosed, the tissue to be treated is clamped by the end effector 4. Theactuation of the end effector 4 to clamp the tissue to be treated may bereferred to as clamping.

As set forth above, after the end effector 4 is in the clamped position,the stop arm 244 of the button 240 is urged into position proximal tothe stop wall 249 in the lumen of the overtube 236. The overtube 236 maybe biased proximally such as by a coil spring within the housing 214connected to both the housing 214 and the overtube 236, or by any othersuitable mechanism or method. Thus, after the end effector 4 has beenclamped, the clamping trigger 220 may be released. The proximal bias ofthe overtube 236 attempts to urge the overtube 236 proximally, therebyurging the stop wall 249 of the overtube 236 into contact against thestop arm 244 of the button 240. This contact holds the overtube 236 inposition, thereby maintaining the end effector 4 in the clampedposition. The surgeon may then remove his or her hand from the clampingtrigger 220, and the end effector 4 remains in the clamped position.

Advantageously, prior to the deployment of staples 18, the feeder belts16 are clamped into place. By locking the feeder belts 16 into place,the wedges 74 are able to deliver force that deforms and shears thestaples 18, rather than moving or deforming the feeder belts 16.Referring to FIGS. 44-45, as one example of clamping the feeder belts 16in place, distal motion of the overtube 236 in turn urges the clamps 161distally, because the clamps 161 are fixed or otherwise coupled to theovertube 236. Distal motion of each clamp 161 causes each tab 322 ofthat clamp 161 to slide upward and distally out of the correspondingslot 324 in the base 62 of the housing 60. Where a tab 322 includes aramp 328 and the corresponding slot 324 includes a corresponding ramp327, the ramp 328 of the tab 322 slides up the corresponding ramp 327 ofthe slot 324, facilitating motion of the clamp 161. The tabs 322 of theclamp 161 then rest on the base 62 of the housing 60, and the uppersurface of the clamp 161 presses upward on the underside of thecorresponding feeder belt 16. In this way, the feeder belt 16 is clampedinto place, and may be tensioned as well.

As another example of clamping the feeder belts 16 in place, referringalso to FIGS. 30-33, the sliding clamps 160 are moved to the secondposition. Such motion may include sliding the upper clamp 162 proximallyand/or sliding the lower clamp 164 distally. During the sliding motion,the tongue 168 of the upper clamp 162 slides along the slot 166 of thelower clamp 164. As the upper clamp 162 and/or lower clamp 164 slide,the cam surfaces 170, 172 engage one another to cause the upper surfaceof the upper clamp 162 to move upward into contact with the feeder belt16. Such contact further stabilizes the feeder belt 16 during contactbetween the wedges 74 and the staples 18.

After clamping, the end effector 4 is configured to deploy staples 18.Referring also to FIGS. 6, 12 and 43, the wedges 74 are in an initialposition, in which each wedge 74 may be distal to the staples 18 in thecorresponding row 26. Further, referring also to FIG. 11, at least onestaple 18 in each row 26 initially is positioned under a correspondingaperture 67 in the top plate 66 of the housing 60. Advantageously, astaple 18 initially is positioned under each aperture 67 in the topplate 66 of the housing 60. Referring to FIGS. 14 and 17A, where theblock 84 is utilized, the block 84 is located at or in proximity to thedistal wall 124 of the recess 120, which is the initial position of theblock 84. Alternately, in its initial position the block 84 may belocated at or in proximity to a proximal end of the recess 120, or maybe located differently relative to the recess 120. In a staple holder 30utilizing the block 84 of FIG. 23, the block 84 may be in an initialposition in the staple holder 30 and/or shaft 6 of the endocutter 2,where the block 84 is at or in proximity to a distal end of a recess orspace in the staple holder 30 and/or shaft 6. Alternately, the block 84may be positioned at or in proximity to a proximal end of a recess orspace in the staple holder 30 and/or shaft 6, or may be positioneddifferently relative to the staple holder 30 and/or shaft 6. Referringto FIGS. 15, 16 and 21, the knife 90 is in an initial position relativeto the staple holder 30, where the cutting edge 110 of the knife 90 maybe held completely within the staple holder 30. At least part of theblade 108 may be held within the staple holder 30 as well. Referringalso to FIG. 8, the blade 108 and cutting edge 110 of the knife 90 maybe located within the distal end 42 of the feeder belt guide 40.

The user then actuates the firing trigger 222 to deploy the staples 18in any suitable manner. As one example, referring to FIGS. 37-38, and asdescribed above, as the firing trigger 222 is compressed toward the heel216 of the housing 214, the tab 262 and teeth 260 located on the headportion 226 of the clamping trigger move partially in the distaldirection. Engagement between the teeth 260 and the first rack 272 ofthe transmission 270 moves the transmission 270 distally, therebycausing the second rack 274 of the transmission 270 to rotate the gear286. Referring also to FIG. 41, the second set of teeth 290 of the gear286 engage the driver rack 294 and move the driver rack 294 proximally.Such proximal motion moves the entirety of the driver 300 proximally,including the wedges 74.

As another example, referring to FIG. 24, actuation of the firingtrigger 222 moves the rod 104 proximally by any suitable mechanism ormethod. As one example, the proximal end of the rod 104 extends into thehandle 8, and a mechanism within the handle 8 moves the rod 104proximally. The mechanism may be actuated by a release of energy storedwithin the handle 8. A mechanism for moving a rod 104 linearly isstandard; any suitable mechanism or mechanisms may be utilized. Proximalmotion of the rod 104 causes the block 84 to move proximally, as aresult of the attachment between the rod 104 and the protrusion 98 fromthe block 84. The proximal motion of the block 84 in turn causes thewedge assemblies 72 and knife 90, which are attached to the block 84, tomove proximally. Alternately, the rod 104 may be rotated instead of, orin addition to, being retracted proximally, where such rotation causesproximal motion of the block 84.

The driver 300 continues to move proximally, such that the wedgeassemblies 72 and wedges 74 move proximally. Proximal motion of thewedge assemblies 72 in turn causes proximal motion of each wedge 74,which in turn causes deployment of the staples 18. For clarity, motionof a single wedge 74 to deploy one or more staples 18 in a correspondingrow 26 is described. The wedge 74 may be initially distal to the staples18 in the corresponding generally-linear row 26, and the path of motionof the wedge 74 may be generally parallel to or collinear with thecorresponding row 26. As the wedge 74 moves proximally, the firstsurface 79 of the wedge 74 contacts the distalmost staple 18 in thecorresponding row. Referring also to FIG. 5, contact between the firstsurface 79 and the staple 18 results in the application of force to thestaple 18. Because the first surface 79 is angled upward in the distaldirection, that force applied to the staple 18 is exerted bothproximally and upward. Further, the force applied to the staple 18results in a moment about the tab 28 that connects the staple 18 to thefeeder belt 16. The moment acts on the staple 18 to rotate the staple 18about the tab 28, such that the free end 22 of the staple 18 movesupward, out of the corresponding aperture 67 in the top plate 66 of thehousing 60 and into the blood vessel 148. Alternately, where the tab 28is not used, the force applied to the staple 18 results in a momentabout the location of the connection of the staple 18 to the feeder belt16. During motion of the wedge 74, the feeder belt 16 may be heldsubstantially in place, either passively such as by friction with thecorresponding nose 50, or actively such as by a brake or clutch (notshown) in the handle 8, shaft 6 and/or end effector 4.

The wedge 74 continues to move proximally, continuing to exert a forceon the staple 18 that causes a moment about the tab 28. As the free end22 of the staple 18 rotates upward, it penetrates completely through theblood vessel 148 and then contacts the lower surface of the anvil 32.Optionally, a standard staple bending feature (not shown) may be definedin the anvil 32 at the location where the free end 22 of the staple 18contacts the anvil 32. As the free end 22 of the staple 18 contacts theanvil 32, the rotation of the staple 18 about the tab 28 results inmotion of the free end 2 both upward and distally. However, contactbetween the free end 22 of the staple 18 and the anvil 32 preventsfurther upward motion of the free end 22 of the staple 18. As a result,the free end 22 of the staple 18 moves distally along the lower surfaceof the anvil 32 and/or staple bending feature defined thereon. Thismotion may bend or deform the leg 20 of the staple 18 associated withthe free end 22, closing the staple 18. The staple 18 may be fabricatedfrom a plastically-deformable material such as stainless steel, suchthat deformation of the staple 18 may be plastic deformation.Alternately, at least part of at least one staple 18 may be elasticallydeformable or superelastically deformable.

As the wedge 74 continues to move proximally, the peak 82 of the wedge74 approaches close to the staple 18, which may be already completely orsubstantially completely deformed against the anvil 32. Alternately,deformation of the staple 18 may continue to the point where the peak 82of the wedge 74 contacts the staple 18. When the peak 82 reaches orcomes close to the staple 18, the force exerted on the staple 18 isprimarily in the upward direction. Further, this force is exerted on thestaple 18 at a location at or in proximity to the tab 28 that connectsthe staple 18 to the feeder belt 16. That force shears, breaks orotherwise separates the staple 18 from the feeder belt 16. The tab 28 isconfigured such that the force exerted by the peak 82 of the wedge 74,or by a portion of the wedge 74 in proximity to the peak 82, issufficient to frangibly separate the staple 18 from the feeder belt 16by shearing, breaking it off or otherwise separating it. Where thestaple 18 and/or tab 28 include a weakened area at or near theirintersection, the staple 18 may shear, break or otherwise separate fromthe feeder belt 16 at that weakened area. The peak 82 may also activelypush, urge or otherwise eject the staple 18 completely out of thehousing 60. Alternately, the staple 18 is passively ejected from thehousing 60, meaning that the staple 18 is not affirmatively urged out ofthe housing 60; rather, it is simply released from the housing 60 andallowed to exit therefrom. At this point, the deformed and ejectedstaple 18 is in position in the blood vessel 148. The frangibility ofthe staples 18 allows the staples 18 to be held securely and reliably bythe feeder belt 16, and thus by the staple holder 30, while providingfor reliable separation and deployment. The second surface 80 does notsubstantially contact the staple 18 or tab 28. Alternately, the secondsurface 80 may be shaped or otherwise configured to assist indeformation and/or ejection of the staple 18.

As another example, the wedge 74 may be configured as shown in FIG. 28.As stated above, the first segment 140 of that wedge 74 may be shaped tofacilitate deployment of the staple 18, and the second segment 142 ofthat wedge 74 may be shaped to facilitate shearing or otherwiseseparating the staple 18 from the feeder belt 16. As the wedge 74 ismoved relative to a staple 18 and contacts that staple 18, the firstsegment 140 of the wedge 74 encounters the staple 18 and applies a forceto that staple 18 proximally and upward to form that staple 18,substantially as described above. The first segment 140 may be shapedsuch that formation of the staple 18 is substantially complete by thetime the first segment 140 of the wedge 74 has moved out of contact withthe staple 18. The second segment 142 may have a shape that facilitatesseparation of the formed staple 18 from the feeder belt 16. As the wedge74 continues to move proximally, the first surface 140 moves out ofcontact with the staple 18, which is substantially formed, and thesecond surface 142 moves into contact with that substantially-formedstaple 18. Where the staple 18 is shaped such as shown in FIGS. 25-27,after that staple 18 has been substantially formed, the bump 136 in thatstaple 18 may be oriented generally downward and in the path of travelof the second surface 142. Thus, as the second surface 142 slidesproximally, it applies a force upward against the bump 136, where thatforce shears, breaks or otherwise separates the formed staple 18 fromthe feeder belt 16.

As another example, the wedge 74 may be configured as shown in FIG. 28A,and the staples 18 may be configured as shown in FIG. 35. As the wedge74 is moved relative to a staple 18 and contacts that staple 18, thefirst ramp 186 approaches the staple 18. The first ramp 186 is shapedand sized to allow the second ramp 188 of the wedge 74 to encounter andapply a force to the distal leg 196 of the staple 18. As a result, thesecond ramp 188 applies a force to that protrusion 198. The protrusion198 pushes tissue toward the anvil 32 as the staple 18 closes, promotingclosure of the tissue. Referring also to FIGS. 7A-7B, as the second ramp188 forces the distal leg 196 of the staple 18 upward, the free end 22of the proximal leg 196 of the staple 18 moves upward into thecorresponding staple forming pocket 204. The free end 22 of the proximalleg 196 may first encounter the proximal section 206 of thestaple-forming pocket 204, which has a first radius of curvature. As thestaple 18 continues to be deformed by force applied by the wedge 74 andthe free end 22 of the proximal leg 196 continues to be forced upward,the proximal section 206 of the staple-forming pocket 204 deforms thatfree end 22. The curvature of the proximal section 206 facilitatesmotion of the free end 22 of the proximal leg 196 along the surface ofthe staple-forming pocket 204 toward the distal section 208 of thatstaple-forming pocket 204. The distal section 208 of the staple-formingpocket 204 has a second radius of curvature shorter than the firstradius of curvature of the proximal section 206 of the staple formingpocket 204. The tighter radius of curvature of the distal section 208facilitates motion of the free end 22 of the proximal leg 196 of thestaple 18 downward, as part of the closing of the staple 18. As thesecond ramp 188 of the wedge 74 forces the free end 22 of the proximalleg 196 of the staple 18 along the staple forming pocket 204, that wedge72 also forces the distal leg 194 of the staple 18 upward. The secondramp 188 may be shaped such that formation of the staple 18 issubstantially complete by the time the second ramp 188 of the wedge 74has moved out of contact with the staple 18. The second segment 142 mayinclude a third ramp 192 that has a shape that facilitates separation ofthe formed staple 18 from the feeder belt 16. The second segment 142 maybe spaced apart a distance from the first segment 188 by a substantiallyflat or otherwise-shaped spaced segment 190. The spacer segment 190 isadvantageously as least as long as the longitudinal dimension of asubstantially-closed staple 18, and is located low enough tosubstantially avoid contact with the staple 18. Alternately, the staple18 may contact the spacer segment 190 during deployment. As the wedge 74continues to move proximally, the first surface 140 moves out of contactwith the staple 18, which is substantially formed, and the third ramp192 moves into contact with that substantially-closed staple 18. As thethird ramp 192 slides proximally, it applies a force upward against thedistal leg 194 of the staple 18, where that force shears, breaks orotherwise separates the formed staple 18 from the feeder belt 16. Wherethe junction between the staple 18 and the feeder belt 16 is coined,that coining concentrates stress at the junction, facilitatingseparation between the staple 18 and the feeder belt 16. The forcerequired to shear, break or otherwise separate a staple 18 from thecorresponding feeder belt 16 may be any suitable amount of force. As oneexample, approximately twenty pounds of force separates the staple 18from the corresponding feeder belt 16. The separation force is selectedto ensure that the staples 18 neither fall off the feeder belt 16 in themiddle of deployment nor require an excessive amount of force toseparate.

After the staple 18 has been separated from the feeder belt 16, thewedge 74 may continue its motion in the proximal direction. As it doesso, it encounters another staple 18, and deforms that staple 18 andseparates that staple 18 from the feeder belt 16 in substantially thesame manner as described above. The wedge 74 may be long enough that, asthe wedge 74 has deformed one staple 18 a substantial amount but thatstaple 18 has not yet separated from the feeder belt 16, the wedge 74engages and begins to deform the next most distal staple 18.Alternately, the wedge 74 is short enough that it completely deforms onestaple 18, which is then ejected, before the wedge 74 engages and beginsto deform the next most distal staple 18.

The block 84 may be controlled to move each wedge assembly 72 andcorresponding wedge 74 longitudinally along a fixed distance, such thata fixed number of staples 18 is deployed by each wedge 74 during eachactuation. As a result, referring also to FIG. 29, the length of eachstaple line 146 in a blood vessel 148 or other tissue is fixed. The term“staple line” refers to the grouping of staples 18 in a row 26 aftertheir ejection into tissue. The block 84 may be controlled to move alonga fixed distance in any suitable manner. As one example, the rod 104 ismovable proximally along that fixed distance during each actuation ofthe endocutter 2. Each fixed number of staples 18 in a row 26 may begrouped together and separated from an adjacent group of staples 18 by ablank space on the feeder belt 16, where that blank space may have anysuitable length. The blank space allows the wedge 74 to be long enoughin the longitudinal direction to engage and begin to deform a secondstaple 18 while that wedge 74 is still completing the deformation and/orejection of the previous staple 18. Thus, when the wedge 74 movesproximally far enough to encounter the blank space, no staple 18 ispresent for that wedge 74 to deform, such that the wedge 74 can completedeformation of each staple 18 in the group without leaving a subsequentstaple 18 partially deformed. However, the wedge may be short enoughthat it completely deforms one staple 18, which is then ejected, beforethe wedge 74 engages and begins to deform the next most distal staple18.

Alternately, the block 84 may be selectively controlled to move eachwedge assembly 72 and corresponding wedge longitudinally along aselectable distance, such that a selected number of staples 18 may bedeployed by each wedge 74 during actuation. In this way, the length ofthe staple line 146 in a blood vessel 148 or other tissue is variable,and selectable by the user. The block 84 may be selectively controlledin any suitable manner. As one example, the rod 104 is movableproximally along a distance selectable by the user during each actuationof the endocutter 2. The rod 104 may be actuated to move along thatselected distance by the handle 8, which also may be configured toreceive user input related to the selected distance. The handle 8 may beconfigured in any suitable manner to control the longitudinal distanceof travel of the rod 104. As one example, the handle 8 may include astepper motor attached to the rod 104 that translates the rod 104 aselected one of a discrete number of lengths. As another example, thehandle 8 may include a mechanical stop that is movable by the user,where the rod 104 stops its proximal motion when it encounters themechanical stop. That is, the rod 104 may be spring-loaded or biasedacross a distance at least as long as the longest selectable staple line146, and the mechanical stop is used to stop travel of the rod 104 at adistance less than the longest selectable staple line 146. Because thedistance across which the wedge 74 travels may vary during eachactuation and is user selectable, advantageously no blank spaces arepresent in each feeder belt 16. In addition, the wedge advantageouslymay be short enough that it completely deforms one staple 18, which isthen ejected, before the wedge 74 engages and begins to deform the nextmost distal staple 18.

Referring to FIGS. 11-12, 14-17 and 36, as the driver 300 or block 84moves proximally, it also moves the knife 90, which is connected to thedriver 300 or block 84 via the hook 92 or other structure at theproximal end of the knife 90. As the knife 90 moves proximally, it cutsthe tissue held between the anvil 32 and the staple holder 30. The knife90 may cut that tissue while the staples 18 are being deformed andejected. In the initial position of the knife 90, the blade 108 islocated completely within the staple holder 30, such that the blade 108does not extend out of the staple holder 30. In this way, the blade 108does not prematurely engage tissue, or pose a hazard to the surgeon. Asthe knife 90 moves proximally from its initial position, the bottom ofthe blade 108 of the knife 90 may engage and ride up the ramp 116 at thedistal end of the retainer 112. As the blade 108 rides up the ramp 116,at least part of the cutting edge 110 of the blade 108 moves above thetop plates 66 of the housing and begins to cut tissue held between theanvil 32 and the staple holder 30. After the blade 108 reaches the topof the ramp 116, it continues to move proximally along the upper surfaceof the extension 114 as the block 84 continues to pull the knife 90proximally. Referring also to FIG. 7A, where the anvil 32 includes aslot 210 defined in its inner surface 210, the upper end of the blade108 may enter and slid along that slot 210 as the knife 90 movesproximally. The slot 210 may provide lateral stability to the blade 108as it translates proximally. At least part of the blade 108 may slidebetween the inner walls 68 of the housing as the knife 90 is pulledproximally. Alternately, the blade 108 may be completely above the innerwalls 68 of the housing, or may move in a different manner. Alternately,the ramp 116 and the extension 114 may be omitted, and the cutting edge110 of the blade 108 may be controlled to rise above the top plates 66of the housing 60 in another manner. Alternately, the blade 108 may becontrolled to move substantially only in the longitudinal direction,such that the blade 108 does not substantially move in the verticaldirection. Where the knife 90 includes a cam surface 107 on its upperedge, the cam surface 107 may be located proximal to the cam engagementfeature 212 in the slot 210, such that the cam surface 107 does notengage the cam engagement feature 212 during proximal motion of theknife 90. Alternately, the can surface 107 of the knife 90 may engagethe cam engagement feature 212 during at least part of the proximalmotion of the knife 90.

After the fixed or selected number of staples 18 have been deformed andejected, motion of the block 84 stops. At this time, the firing trigger222 may be locked into position by the stop arm 244 of the button 240,by a different part of the button 240, or by a different mechanism. Whenmotion of the block 84 stops, the block 84, wedges 74 and blade 108 areeach in a final position. The blade 108 is sized and shaped such thatthe blade 108 has completely cut through the tissue held between theanvil 32 and the staple holder 30 when the blade 108 is in the finalposition. In the final position, at least one wedge 74 and/or the blade108 may be proximal to the corresponding receiving space 70 in thehousing 60. Alternately, the wedges 74 and/or blade 108 may remainwithin the corresponding receiving space 70 in the housing 60 in theirfinal position.

As another example of actuation of the endocutter 2, the wedge 74 may beinitially proximal to the staples 18 in the corresponding row 26, andthe wedge 74 is moved distally rather than proximally to deploy one ormore staples 18 in that row 26. Such distal motion of the wedge 74 maybe caused by, for example, moving the rod 104 in the distal direction.Where the wedge 74 is moved distally to deploy staples 18, the firstsurface 79 and the second surface 80 of the wedge 74 may be shapeddifferently in order to deploy the staples 18 properly. Further, thestaples 18 may be oriented backward relative to the feeder belt 16, suchthat the free end 22 of each staple 18 is located distal to the point ofattachment between the staple 18 and the feeder belt 16. The otheraspects of operation of the staple holder 30 also are performedsubstantially in reverse order from the order described above, in orderto deform the staples 18 and separate them from the feeder belt 16.

After the fixed or selected number of staples 18 have been deformed andejected, and the cutting edge 110 of the blade 108 has transected thetissue held between the anvil 32 and the staple holder 30, the endeffector 4 is unclamped, releasing the tissue. Referring also to FIG.29, where that tissue is a blood vessel 148, the blood vessel 148 hasbeen transected into two segments, each of which has staggered rows ofstaples 18 forming a staple line 146 near an end thereof. Each wedge 74actuated staples 18 in the corresponding row 26, and as set forth aboutthe staples 18 and the apertures 67 in the top plate 66 of the housing60 are staggered. By staggering the rows 26 of staples 18 in a stapleline 146, hemostasis at the end of the blood vessel 148 is facilitated,because the leak path is longer in length and more convoluted than ifthe rows 26 of staples 18 were not staggered.

The end effector 4 may be unclamped in any suitable manner. As oneexample, referring to FIGS. 7 and 37, the anvil 32 and the staple holder30 may be biased apart from one another to an open position, such thatsliding the overtube 236 proximally unclamps the end effector 4 andallows the anvil 32 and staple holder 30 to open. The overtube 236itself may be unlocked from the position it maintains while the endeffector 4 is in the clamped position in any suitable manner. As oneexample, referring also to FIG. 38, in order to allow the overtube 236to slide proximally, the surgeon may depress the finger pad 248 of thebutton 240. This depression rotates the stop arm 244 of the button 240upward out of contact with the stop wall 249 of the overtube 236, suchthat contact between the stop arm 244 and the stop wall 249 no longerrestrains the overtube 236 against proximal motion. As described above,the overtube 236 may be biased in the proximal direction, such thatmovement of the stop arm 244 out of contact with the stop wall 249 ofthe overtube 236 results in proximal motion of the overtube 236.

Proximal motion of the overtube 236 may release the anvil 32 and stapleholder 30, unclamping the end effector 4. Proximal motion of theovertube 236 may also reset the end effector 4 for another firing,during unclamping of the end effector 4 from the previous firing. Byautomatically resetting the endocutter 2 for another firing duringunclamping from the previous firing, use of the endocutter 2 issimplified, and the surgeon need not undertake, or remember, additionalactions to reset the endocutter for another firing. Proximal motion ofthe overtube 236 may also reset the clamps 161 to their initial,prefiring positions. Referring also to FIGS. 44-45, as the overtube 236moves proximally, it moves the clamps 161 coupled thereto in theproximal direction as well. Proximal motion of each clamp 161 causeseach tab 322 of that clamp 161 to slide downward and proximally into thecorresponding slot 324 in the base 62 of the housing 60. Where a tab 322includes a ramp 328 and the corresponding slot 324 includes acorresponding ramp 327, the ramp 328 of the tab 322 slides down thecorresponding ramp 327 of the slot 324, facilitating motion of the clamp161 in a manner that moves the upper surface of the clamp 161 out ofengagement with the corresponding feeder belt 16. The tabs 322 of theclamp 161 then rest in the corresponding slots 324. As the overtube 236moves proximally, contact between the engagement feature 238 of theovertube 236 and the free end 234 of the clamping trigger 220 rotatesthe clamping trigger 220 about the axle 218, urging the grip portion 232of the clamping trigger 220 away from the heel 216 of the housing 214.In this way, the clamping trigger 220 is reset for subsequent clampingof the end effector 4 at a different location.

Referring also to FIGS. 37-38, the firing trigger 222 may be reset atsubstantially the same time as the clamping trigger 220. The firingtrigger 222 may be released by depression of the finger pad 248 of thebutton 240, or in any other suitable manner. The firing trigger 222 maybe biased outward to its initial position. As another example, motion ofthe clamping trigger 220 away from the heel 216 of the housing 214forces the firing trigger 222 outward from the heel 216 as well, orassists in moving the firing trigger 222 away from the heel 216. As thefiring trigger 222 moves away from the heel 216 of the housing 214, thetab 262 and teeth 260 located on the head portion 226 of the clampingtrigger move partially in the proximal direction. Engagement between theteeth 260 and the first rack 272 of the transmission 270 moves thetransmission 270 proximally, thereby causing the second rack 274 of thetransmission 270 to rotate the gear 286. Referring also to FIG. 41, thesecond set of teeth 290 of the gear 286 engage the driver rack 294 andmove the driver rack 294 distally. Such distal motion moves the entiretyof the driver 300 distally, including the wedges 74. The distal motioncontinues until the driver 300 is in the initial, prefiring position. Asdescribed above, the knife 90 may be fixed to the driver 300. As aresult, as the driver 300 moves distally, it urges the knife 90 distallyas well. Referring also to FIG. 36, as the knife 90 moves distally, thecam surface 107 of the knife 90 may engage the cam engagement feature212 within the slot 210 of the anvil 32. Engagement between the angledcam surface 107 and the cam engagement feature 212 acts to move theblade 108 of the knife 90 downward as the knife 90 moves proximally. Theblade 108 moves downward into the initial position, completely withinthe staple holder 30 such that the blade 108 does not extend out of thestaple holder, as the knife 90 moves toward its final, distalmostposition. Alternately, the knife 90 may be moved back to its initialposition in any other suitable manner.

Referring to FIGS. 8-10 and 14-17, as another example, the handle 8 maybe actuated to return the block 84 to its initial position after the endeffector 4 has been returned to its open position. Alternately, theblock 84 is returned to its initial position when the end effector 4returns to its open position, or at a different time. The rod 104 may bemoved in the proximal direction to return the block 84 to its initialposition. Alternately, the block 84 may be returned to its initialposition in any other suitable manner. As one example, the block 84 maybe biased distally, such that the rod 104 may be released and the block84 automatically returns to the initial position. As another example,the block 84 may be biased proximally, such that the rod 104 is notaffirmatively moved proximally to deploy and eject the staples 18. Ifso, the rod 104 then may be used to push the block 84 distally to itsinitial position and hold the block 84 in that initial position.Alternately, the block 84 may be returned to its initial position in anyother suitable manner. As the block 84 moves back to its initialposition, it moves the wedges 74 and the blade 108 back to their initialpositions, reversing the paths traveled by the wedges 74 and blade 108during actuation of the end effector 4. Alternately, the wedges 74and/or blade 108 may move in a different manner and/or along a differentpath to return to their initial positions. Because the staples 18 thatwould otherwise be in the path of the wedges 74 have been deployed outof the housing 60, the wedges 74 may return to their initial positionsubstantially without interference. Further, because the tissue has beenreleased from the end effector 4, the blade 108 returns to its initialposition substantially without contacting tissue.

At this point, the wedges 74 and blade 108 are in their initialpositions. Next, if the feeder belt 16 was restrained against motionduring the previous actuation of the end effector 4 by the slidingclamps 160, those sliding clamps are returned to the first position, inwhich the upper claim 162 does not restrain the feeder belt 16. Suchmotion may include sliding the upper clamp 162 distally and/or slidingthe lower clamp 164 proximally. During the sliding motion, the tongue168 of the upper clamp 162 slides along the slot 166 of the lower clamp164. As the upper clamp 162 and/or lower clamp 164 slide, the camsurfaces 170, 172 engage one another to cause the upper surface of theupper clamp 162 to move downward out of contact with the feeder belt 16,to allow the feeder belt 16 to advance. If a different or additionalrestraint such as a brake or clutch in the handle 8, shaft 6 or endeffector 4 was used, that restraint is released.

As the endocutter 2 the feeder belt 16 are moved in order to advancefresh staples 18 into the housing 60 of the staple holder 30. Thismotion of the feeder belt 16 may be referred to as “advancing” thefeeder belt 16, regardless of the fact that some or all of the feederbelt 16 may be moved in a direction other than distally during thatadvancing. Advancing the feeder belt 16 may be accomplished in anymanner. Each feeder belt 16 may be routed around a corresponding pulley180 or nose 50, along a path that starts generally straight and in thedistal direction, then is curved along the surface of the correspondingpulley 180 or nose 50, and then is generally straight and in theproximal direction, such that the pulley 180 or nose 50 changes thedirection of motion of the corresponding feeder belt 16 from generallydistal to generally proximal. As a result, referring also to FIG. 35,each continuous feeder belt 16 may include an upper section 366 and alower section 368 substantially parallel to the upper section 366. Thedistal end of the top plate 340 may be fixed to the proximal end of theupper section 366 of a feeder belt 16, and the distal end of the bottomplate 360 may be fixed to the proximal end of the lower section 368 ofthe feeder belt 16. Referring also to FIGS. 46-47, the top plate rack346 and the bottom plate rack 362 each engage one or more spur gears350, as described above. Referring also to FIG. 42, as the driver 300moves distally during the reset process, as described above, the pawl314 of the driver 300 moves distally as well. As the pawl 314 movesdistally, the stop 316 of the pawl 314 engages a face 344 of acorresponding ratchet ramp 342 of the top plate 340. As a result,continued distal motion of the pawl 314 urges that face 344 distally,thereby urging the top plate 340 distally. This distal motion of the topplate 340 causes the top plate rack 346 to rotate the corresponding spurgear or gears 350, which in turn causes the bottom plate rack 362 andhence the bottom plate 360 to move distally. Such distal motion of thebottom plate 360 pulls the lower section 368 of the feeder belt 16proximally. As the lower section 368 of the feeder belt 16 movesproximally, the feeder belt 16 is pulled around the corresponding pulley180 or nose 50. The use of the pulley 180 may reduce friction andthereby may reduce the amount of force needed to pull the feeder belt 16as compared to the use of the nose 50. As the lower section 368 of thefeeder belt 16 moves proximally, the upper section 366 of the feederbelt thereby moves distally, moving a fresh, unfired set of staples 18into the housing 60. Each feeder belt 16 is thus reset for anotherfiring of the end effector 4. Further, each feeder belt 16 is thusautomatically reset upon unclamping of the end effector 4.

As another example, referring also to FIG. 25, one or more openings 132in the feeder belt 16 are engaged by one or more gears, pins or othermechanisms, such that engagement with the openings 132 is used toadvance the feeder belt 16. As another example, any other suitablemechanism, structure or method may be used to move the feeder belt 16 inorder to advance fresh, undeployed staples 18 into the housing 60. Wherethe feeder belt 16 is movable generally linearly, and the nose 50 is notutilized, the housing 60 may be longer, and the feeder belt 16 is simplyadvanced or retracted generally linearly in order to advance freshstaples 18 into the housing 60.

The feeder belt 16 may be advanced with or without feedback. As anexample of advancing the feeder belt 16 without feedback, a steppermotor or other mechanism may be used to advance the feeder belt 16 afixed distance each time. Where feedback is provided, the feeder belt 16is advanced a distance that is related to the feedback; that distancemay not be fixed every time. As one example, a pinwheel (not shown) maybe configured to engage the openings 132 in the feeder belt 16 withpins, such that motion of the feeder belt 16 causes the pinwheel torotate. Such rotation of the pinwheel may produce mechanical orelectrical feedback that is transmitted mechanically or electrically tothe handle 8, such that advancement of the feeder belt 16 continuesuntil the pinwheel has rotated a particular amount. In this way, thepinwheel provides confirmation that the feeder belt 16 has in factadvance to a position in which unfired staples 18 are in position in thehousing 60 at locations corresponding to the apertures 67 in the topplates 66 of the housing 60. As another example of feedback, an opticalsensor or sensors (not shown) may be positioned in the end effector 4 tosense the openings 132, such that the optical sensor or sensors candetermine the degree of advancement of the feeder belt 16. As anotherexample, any other suitable mechanism may be used to generate feedbackand to transmit that feedback in mechanically, electrically and/or asdata to a suitable controller, which may be located in the handle 8 orin any other portion of the endocutter. The controller may be a cam, anintegrated circuit, a microprocessor, an analog circuit or circuits, adigital circuit or circuits, a mechanical computer, or any othersuitable controller

Next, the endocutter 2 may be fired again substantially as describedabove. Referring to FIGS. 42 and 46-47, upon refiring the endocutter 2,the driver 300 moves proximally, thereby moving the pawl 314 proximally.The pawl 314 moves proximally relative to a ratchet ramp 342 of the topplate 340, thereby gradually flexing the pawl 314 downward away from thetop plate 340. The pawl 314 then moves proximal to the face 344 at theproximal end of that ratchet ramp 342 and springs back upward, such thatthe stop 316 is proximal to the face 344. In this way, the stop 316 ofthe pawl 314 is prevented from moving distally past the face 344 withoutmoving the face 344 to ratchet the top plate 340, as described above.The endocutter 2 may be fired again without removing the end effector 4from the patient, changing a cartridge or other disposable stapleholder, or reloading the end effector 4 from outside the endocutter 2.In this way, the end effector 4 may be actuated multiple times withoutremoving the end effector 4 through the trocar port 10 or otherincision, structure or mechanism that allows access to the interior ofthe body of the patient. Keeping the end effector 4 within the body ofthe patient without withdrawing that end effector 4 through the trocarport 10 or other incision, structure or mechanism that allows access tothe interior of the body of the patient may be referred to asmaintaining the end effector within the body of the patient. Anindicator may be provided in the handle 8 or at another location in theendocutter 2 that shows how many unfired staples 18 remain in theendocutter 2. The endocutter 2 may be actuated multiple times within thepatient, without being removed from the patient, until the staples 18 inthe endocutter 2 are exhausted. At such time, the end effector 4optionally may be locked out in any suitable manner, such as bypreventing clamping of tissue, or preventing actuation of the firingtrigger 222.

Actuation of the endocutter 2 above has been generally described interms of deployment and ejection of a single row 26 of staples 18 forclarity, where that deployment and ejection may be performed insubstantially the same manner along each row 26 of staples 18. Operationof the endocutter 2 may be substantially as described above with regardto any number of rows 26 of staples 18 on a feeder belt 16. That is, anendocutter 2 having two rows 26 of staples 18 on a feeder belt 16, ormore than three rows of staples 18 on a feeder belt 16, may be actuatedsubstantially as described above.

Driverless Endocutter and Operation

Optionally, referring to FIGS. 12, 13 and 28, the wedges 74 may be fixedin place relative to the staple holder 30. For example, the wedges 74may simply be molded, cut, formed or otherwise fabricated as part of thefeeder belt guide 40 or other component of the end effector 4. As eachfeeder belt 16 is advanced, the most distal unformed staple 18 in eachrow 26 contacts the stationary wedge 74. The feeder belt 16 then doesnot stop, but continues to move. As the feeder belt 16 continues toadvance, the relative motion between the feeder belt 16 and thestationary wedge 74 causes the staple 18 to deform and then separatefrom the feeder belt 16, in substantially the same manner as describedabove with regard to motion of the wedge 74 relative to thesubstantially stationary feeder belt 16. Where the wedges 74 arestationary, the end effector 4 does not apply a row of staples 18longitudinally along a staple line. Instead, the end effector 4sequentially deploys the distalmost staple 18 in each row 26 as thefeeder belt 16 pulls that staple 18 onto the corresponding wedge 74.

Alternately, for a single-use device, a number of wedges 74 equal to thenumber of staples 18 to be deployed are fabricated as part of the endeffector 4, and are each located immediately proximal or distal to thecorresponding staple 18. As the feeder belt 16 is moved longitudinally,each staple 18 contacts the corresponding fixed wedge 74, deforms to aclosed configuration, and then separates from the feeder belt 16. Inthis way, two or more staples 18 can be deployed along a staple line atthe same time, without the use of wedge assemblies 72. Optionally, thewedges 74 may be movable downward or in another direction from a firstposition after deploying the staples 18, such that a feeder belt 16 canbe advanced to place new, undeployed staples 18 in position for firing,after which the wedges 74 may be moved back to their first position.

Other Surgical Tools Utilizing Feeder Belt

As described above, the feeder belt 16 and attached staples 18 of FIGS.4-6, 18-20, 25-27, and 30-33 may be used in the end effector 4 of anendocutter 2. However, the feeder belt 16 and attached staples 18 may beused in any suitable surgical tool, for human or veterinary use. As oneexample, the feeder belt 16 and attached staples 18 may be used in ananastomosis tool, such as described in U.S. patent application Ser. No.11/054,265, filed on Feb. 9, 2005 (the “'265 application”), which ishereby incorporated by reference in its entirety. For example, thefeeder belt 16, attached staples 18, and any other suitable part of themechanism described above may be placed in each arm 402 of the stapleholder 38 of the '265 application in lieu of the sled 482, staples 464,connector bays 448, connector deployers 452, and/or other structuresand/or mechanisms described in the '265 application as being present inthe arm 402. As a result, the anastomosis tool of the '265 applicationmay be actuated multiple times. Further, the arms 402 of the stapleholder 38 of the '265 application may be made smaller due to the smallersize of the staples 18 and the reduced amount of space required to holdthe feeder belt 16, allowing for the anastomosis of smaller vessels toone another, and allowing the staple holder 38 to access areas of thebody that a larger staple holder could not. As another example, thefeeder belt 16 and attached staples 18 may be used in an end-to-endanastomosis stapler, such as described in U.S. Pat. No. 6,942,675 (the“'675 patent”), which is hereby incorporated by reference in itsentirety. For example, the feeder belt 16 and attached staples 18 may beplaced in each arm 22, 24 of the anastomosis tool 30, in lieu of any orall of the mechanisms and/or structures described in the '675 patent asbeing present in the arms 22, 24. As a result, the anastomosis tool 30may be made smaller, facilitating the end-to-end connection of a greaterrange of vessels, thereby further facilitating the performance ofmicrosurgery. The anastomosis tool 30 may be placed adjacent to thevessels to be connected, such as blood vessels, and actuated asdescribed in the '675 patent, where the deployment of staples 18 may beperformed substantially as described above.

As another example, the feeder belt 16 and attached staples 18 may beused in an intravascular stapler, such as described in U.S. patentapplication Ser. No. 11/158,413 (the “'413 application”), which ishereby incorporated by reference in its entirety. For example, thefeeder belt 16, attached staples 18, and any other suitable part of themechanism described above may be placed in the housing 14 of the staplerhead 8 in lieu of any or all of the mechanisms and/or structuresdescribed in the '413 application as being present in the housing 14 ofthe stapler head 8. As a result, the stapler head 8 of the '413application may be made smaller, facilitating intravascular access to agreater range of blood vessels. The stapler head 8 may be placedadjacent to vascular tissue, and actuated as described in the '413application, where the deployment of staples 18 may be performedsubstantially as described above.

As another example, the feeder belt 16 and attached staples 18 may beused in a bariatric or gastrointestinal stapler, such as used in agastric bypass procedure or other procedures performed on the digestivesystem. The stapler may be placed adjacent to gastrointestinal tissue,such as the stomach, the small intestine or the large intestine, and thedeployment of staples 18 may be performed substantially as describedabove.

The feeder belt 16 and attached staples 18 may be used in any suitablesurgical tool, regardless of whether that tool includes a knife 90 orother structure, mechanism or method for incising or cutting tissue. Asone example, the feeder belt 16 and attached staples 18 may be used in askin stapler for closing a pre-existing wound or incision. The skinstapler may be placed adjacent to the skin, and the deployment ofstaples 18 may be performed substantially as described above.

Deployment of Different Size Staples

As set forth above, the staple line to be created with the end effector4 may be fixed at a particular number of staples 18, and consequentlythe staples 18 in each row may be grouped together in groups each havinga length substantially the same as that fixed staple line. If so, eachgroup of staples 18 in a row 26 may be separated from a adjacent groupof staples 18 by a blank space on the feeder belt 16, where that blankspace may have any suitable length. Of course, the groups of staples 18need not be separated by blank space.

The staples 18 in each group may have a different size than staples 18in one or more other groups. For example, the feeder belt 16 may includea first group of staples 18, then a second group of staples 18 smallerthan those of the first group, then a third group of staples 18substantially the same size as the staples 18 in the first group. Such afeeder belt 16 may be useful in, for example, roux-en-y surgery orsleeve gastrectomy, where current procedure requires surgeons to use astapler with a cartridge that holds larger staples for the first firing,where the edge of the stomach bunches up, then reload the stapler with adifferent cartridge that holds smaller staples for the second firing,where only two layers of stomach are stapled, then reload the staplerwith a different cartridge that holds larger staplers to staple thefundus, which is a thicker portion of the stomach. Indeed, theparticular sequential grouping of staples 18 of different sizes onfeeder belts 16 in the endocutter 2 is contemplated to besurgery-specific, where a particular procedure (such as the roux-en-y orsleeve gastrectomy described above) is well known, and the endocutter 2can be made specific to that surgery. In this way, groups of staples 18of different sizes may be deployed without user input as to the size ofstaples 18 to be deployed.

Where the feeder belt 16 is configured to deploy staples 18 havingdifferent sizes, the apertures 67 in each top plate 66 may be sized toadmit the largest of the staples 18 held by the corresponding feederbelt 16. Alternately, the apertures 67 along each row may be replaced bya slot substantially as long as the collected apertures 67 in that rowwould have been. The staple forming pockets 204 are shaped and locatedon the surface of the anvil 32 oriented generally toward the stapleholder 30 such that they are able to satisfactorily bend staples 18 ofall sizes held on the corresponding feeder belt 16.

Alternately, a plurality of feeder belts 16 may be located on eitherside of the between the inner walls 68 of the housing 60, or otherwiselocated on either side of the knife 90. At least one feeder belt 16 oneach side of the knife 90 may include a plurality of the same sizestaple 18, where at least one other feeder belt 16 on the same side ofthe knife 90 may include a plurality of staples 18 having a differentsize. For example, eight feeder belts 16 may be provided, four on eitherside of the knife 90, where two feeder belts 16 on each side of theknife 90 may include one size of staple 18 and the other two feederbelts 16 on the same side of the knife 90 may include a different sizeof staple 18. Such belts may be arranged laterally relative to oneanother in any suitable manner. As one example, they may be arrangedalternately relative to one another; as another example, they may bearranged two by two, with the two feeder belts 16 with larger staples 18grouped together either laterally inboard from or outboard from the twofeeder belts 16 with smaller staples 18. As another example, four feederbelts 16 may be provided, two on either side of the knife 90, where eachfeeder belts 16 on each side of the knife 90 includes a different sizeof staple 18. Each set of feeder belts 16 may be independently actuated,such that after feeder belts 16 deploy staples 18 of a particular size,only those feeder belts 16 are advanced, and the feeder belts 16 holdingstaples 18 of a different size remain in place.

Alternately, the handle 8 may be motorized and computer controlled. Eachfeeder belt 16 may then include a number of different sizes of staples18. The surgeon may select a size of staple 18, and the motorized handle8 may then advance or retract the feeder belts 16 until a set of staples18 matching the selected size are in firing position. If staples 18matching the selected size are no longer available, the handle 8 may soindicate to the surgeon.

As another example, one feeder belt 16 could include two or moredifferent rows 26 of staples 18, where the staples 18 in one row 26 havea different size than the staples 18 in at least one other row 26. Forexample, a feeder belt 16 may include two rows 26 of staples, where onerow 26 of staples 18 is closer to the knife 90 and the second row 26 ofstaples 18 is laterally further away from the knife 90. The row 26 ofstaples 18 closer to the knife 90 may have a first size, and the row 26of staples 18 further from the knife 90 may have a second size smallerthan the first size. As another example, where two or more feeder belts16 are located on one lateral side of the knife 90, one feeder belt 16may include at least one row of staples 18 having a first size, and atleast one other feeder belt 16 on the same lateral side of the knife 90may include at least one row of staples 18 having a second sizedifferent from the first size. Generally speaking, staples 18 of anysize or variation in sizes may be placed in any desired arrangement onone or more feeder belts 16 in the staple holder 30.

The feeder belt or belts 16 may be fixed to and immovable relative tothe staple holder 30, regardless of the sizes of the staples 18 affixedto the feeder belt or belts 16 and/or any variance in size thereof. Asset forth above, the feeder belt 16 may be a long, narrow, thin strip ofmaterial from which one or more staples 18 extend; it is not required tomove or advance. Additionally as set forth above, a portion of a feederbelt 16 is positioned within the end effector 4; that “portion” mayrefer to the entirety of the feeder belt 16, such that the entirety of afeeder belt 16 may be held within the staple holder 30. Where the feederbelt or belts 16 are fixed to the staple holder 30, the staple holder 30may be, but need not be, configured as a cartridge that is detachablefrom a remainder of the endocutter 2. Staples 18 may be deployed fromthe detachable staple holder 30 in the same manner as described above,after which the cartridgized staple holder 30 is detached from aremainder of the endocutter 2, and then replaced with a cartridge thatincludes fresh, unfired staples 18.

While the invention has been described in detail, it will be apparent toone skilled in the art that various changes and modifications can bemade and equivalents employed, without departing from the presentinvention. It is to be understood that the invention is not limited tothe details of construction, the arrangements of components, and/or themethod set forth in the above description or illustrated in thedrawings. Statements in the abstract of this document, and any summarystatements in this document, are merely exemplary; they are not, andcannot be interpreted as, limiting the scope of the claims. Further, thefigures are merely exemplary and not limiting. Topical headings andsubheadings are for the convenience of the reader only. They should notand cannot be construed to have any substantive significance, meaning orinterpretation, and should not and cannot be deemed to indicate that allof the information relating to any particular topic is to be found underor limited to any particular heading or subheading. Therefore, theinvention is not to be restricted or limited except in accordance withthe following claims and their legal equivalents.

What is claimed is:
 1. A surgical apparatus, comprising: a stapleholder; at least one feeder belt fixed to said staple holder; aplurality of staples integral with and frangibly separable from said atleast one feeder belt; and a wedge longitudinally moveable relative tothe plurality of staples; wherein at least one of said staples is sizeddifferently from at least one other said staple and wherein a surface ofthe wedge contacts a staple of the plurality of staples for deploymentof the staple.
 2. The surgical apparatus of claim 1, wherein saidstaples are organized into at least two separate rows on said feederbelt, and wherein the staples in one said row are sized differently thanthe staples in at least one other said row.
 3. The surgical apparatus ofclaim 1, wherein said staple holder is a detachable cartridge.
 4. Thesurgical apparatus of claim 1, wherein the entirety of said feeder beltis held within said staple holder.
 5. The surgical apparatus of claim 1,wherein at least one of said staples has two extremities, one of whichis free and one of which is fixed to the corresponding said feeder belt.6. The surgical apparatus of claim 1, wherein motion of the wedgedeploys a staple of the plurality of staples.
 7. The surgical apparatusof claim 1, wherein a surface of the wedge has different angles toaccommodate deployment of both the at least one of said staples that issized differently and the at least one other said staple.
 8. A surgicalapparatus, comprising: a staple holder; a plurality of feeder beltsfixed to and immovable relative to said staple holder; a wedgelongitudinally aligned with a plurality of staples; a plurality ofstaples integral with and frangibly separable from each said feederbelt; wherein at least one of said staples is sized differently from atleast one other of said staples and wherein a surface of the wedgecontacts a staple of the plurality of staples for deployment of thestaple.
 9. The surgical apparatus of claim 8, wherein said staplesintegral with at least one of said feeder belt are sized differentlythan said staples integral with at least one other said feeder belts.10. The surgical apparatus of claim 8, wherein at least one of saidstaples integral with at least one said feeder belts is sizeddifferently than at least one said staple integral with at least oneother of said feeder belts.
 11. The surgical apparatus of claim 8,wherein said staples are organized into at least one row on at least twoof said feeder belts, and wherein the staples in one said row of onesaid feeder belt are sized differently than the staples in one othersaid row of one other said feeder belt.
 12. The surgical apparatus ofclaim 8, wherein said staple holder is a detachable cartridge.
 13. Thesurgical apparatus of claim 8, wherein the entirety of said feeder beltis held within said staple holder.
 14. The surgical apparatus of claim8, wherein at least one said staple has two extremities, one of which isfree and one of which is fixed to the corresponding said feeder belt.15. The surgical apparatus of claim 8, wherein motion of the wedgedeploys a staple of the plurality of staples.
 16. The surgical apparatusof claim 8, wherein a surface of the wedge has different angles toaccommodate deployment of both the at least one of said staples that issized differently and the at least one other said staple.